Research On Key Risk Factors Analysis Associated With Hospital Delay Among Stroke Patients

Background and PurposeIn China,stroke has become the leading cause of death.Among the pathological types of stroke,ischemic stroke is the most common type,accounting for about80%.Because of its high incidence,disability,mortality and recurrence rates,it increases the disease burden and imposes a heavy economic burden.Evidence-based medicine indicates that the most effective treatment for ischemic stroke is early thrombolytic therapy,but thrombolytic therapy has obvious time dependence,and the main reason for the insufficiency and low efficiency of thrombolytic therapy is delayed treatment.There are many risk factors affecting the delay of medical treatment,which involve many links.Therefore,it is urgent to analyze the key risk factors of the delay of medical treatment and strengthen the risk management.However,there are few studies on the risk management of delayed stroke treatment in China.The purpose of this study is to establish a risk assessment system for patients with stroke delay,identify the key risk factors of the delay,and provide a scientific and reliable basis for proposing targeted management strategies for stroke delay.MethodsWith the "risk management(RM)" theory as the basic framework,the literature research method was adopted to identify the factors of delayed medical treatment for stroke patients by referring to relevant literature guides at home and abroad.After expert interviews and several research groups’ discussions,the initial risk assessment table for delayed medical treatment for stroke patients was formed.Two rounds of expert letters were used to screen and modify the risk factors in the evaluation table to form a formal evaluation table for the risk of delayed medical treatment for stroke patients.In this paper,450 cases of ischemic stroke patients and 212 cases of doctors in related fields in Harbin were investigated with formal evaluation form.Five methods including subjective evaluation method,discrete trend method,correlation coefficient method,entropy value method and TOPSIS method were used to analyze the risk factors at each stage,and extract the key risk factors that have an important impact on the delay in medical treatment.ResultsThe risk assessment table for stroke patients’ medical delay was constructed,and the medical delay was divided into three stages: patient delay,transport delay and hospital delay.Among them,there were 23 risk factors in the patient delay stage,7 in the transport delay stage and 14 in the hospital delay stage,a total of 44 risk factors.Both the overall CVI and the three-stage CVI in the expert letter evaluation form are greater than the recommended value of 0.78.The Cranbach’s score on the evaluation form is 0.943.According to the above five methods,a total of 18 key risk factors were extracted from the 44 risk factors: 9 in the patient delay stage,4 in the transport delay stage,and 5 in the hospital delay stage.ConclusionsThe factors leading to the delay of medical treatment in patients with ischemic stroke are numerous and complicated.The 18 key risk factors selected in this study are the most important factors affecting the medical treatment efficiency of patients,which are practical and representative.In combination with the degree and proportion of risk factors at each stage on patients’ delay in seeking medical treatment,it is necessary to focus on improving patients’ own risk coping ability,improve relevant procedures and systems around the process of seeking medical treatment,and provide basis for intervention strategies to reduce patients’ delay in seeking medical treatment.