Optimizing Community-Based Stroke Management

Predictors and Prevention of Pneumonia after Stroke

Pneumonia is a frequent and serious complication occurring after stroke, yet the predictors of pneumonia and the independent contribution of pneumonia to outcomes after stroke are poorly known. The degree to which pneumonia after stroke is preventable, and the effectiveness of various care processes aimed at decreasing pneumonia risk, have not been rigorously studied.

Dr. Katzan and other SORP researchers are studying this important issue. Using a large community-based cohort of Medicare patients hospitalized for acute stroke in northeastern Ohio, they are evaluating the effect of process of care measures on occurrence of pneumonia and developing a clinically useful prediction rule to identify patients most likely to benefit from preventive interventions.

The results of this proposed comprehensive study will provide information on the economic and public health importance of pneumonia to guide health policy decisions. Knowledge of effective process of care measures and their cost-effectiveness will be of direct importance to the clinical management of hospitalized stroke patients and identify and guide the use of effective interventions. Better understanding of the risk factors for pneumonia and the clinical prediction rule would allow physicians and hospitals to focus strategies on those at increased risk and would allow hospital systems to compare their performance to what is predicted.

Members of the Community-based stroke management abstraction team (left to right): Miriam Palmer CRC, Nancy Konrad RN, Siobhan Martin RN ND, Irene Katzan MD MS, Katherine Haas RN.

Other Aspects of Hospital Management after Stroke

Several additional aspects of hospital-based stroke management are being evaluated. Some of these include the impact of laboratory values on the mortality of patients with stroke, differences in management according to gender, after adjustment for severity of illness and presence of Do-Not-Resuscitate orders, the impact of time to feeding on outcomes after stroke, and the impact of chronic immunosuppression on the occurrence of infectious complications.