Vol 55, No 6 (2021)
Research Paper
Published online: 2021-11-16
Association between intention to call EMS in stroke patients and level of hospital classification and emergency medical service usage among stroke patients in China
Abstract
Introduction: Different categories of hospitals in China have varying levels of patient education. Stroke recognition and emergency medical services (EMS) usage in patients appears to be closely associated with patient education in hospital. This study aimed to explore the effect of hospital classification in China on a patient’s ability to recognise stroke symptoms and the likelihood of using the EMS.
Material and methods: A cross-sectional, community-based study was conducted from January to May 2017, and 1,426 residents who had previously been hospitalised were analysed. The patients involved in the study were from 69 administrative areas in China. Multivariable logistic regression models were developed separately for primary, secondary, and tertiary hospitals to identify the associations between hospital grades and patient stroke recognition or the prospects of them using the EMS.
Results: Among the 1,426 patients studied, 725 had been admitted to tertiary hospitals, 448 to secondary hospitals, and 253 to primary hospitals. According to univariate analysis, tertiary hospital patients were more likely to use the EMS than patients in primary and secondary hospitals. The difference therein was still significant after full adjustment.
Conclusions: Patients in tertiary hospitals were significantly more likely to use the EMS promptly compared to patients in primary or secondary hospitals. Therefore, patient education on timely EMS usage at stroke onset should be enhanced in primary and secondary hospitals in China.
Keywords: secondary preventionChinese hospital grading systempatient educationawarenessemergency
References
- Liu L, Liu J, Wang Y, et al. Substantial improvement of stroke care in China. Stroke. 2018; 49(12): 3085–3091.
- Pandian JD, Gall SL, Kate MP, et al. Prevention of stroke: a global perspective. Lancet. 2018; 392(10154): 1269–1278.
- Pan Y, Zhao X, Jiang Y, et al. Prevalence, knowledge, and treatment of transient ischemic attacks in China. Neurology. 2015; 84(23): 2354–2361.
- Yin X, Yang T, Gong Y, et al. Determinants of emergency medical services utilization among acute ischemic stroke patients in Hubei province in China. Stroke. 2016; 47(3): 891–894.
- Patel A, Fang J, Gillespie C, et al. Awareness of stroke signs and symptoms and calling 9-1-1 among US adults: national health interview survey, 2009 and 2014. Prev Chronic Dis. 2019; 16: E78.
- Yang J, Zheng M, Chen S, et al. A survey of the perceived risk for stroke among community residents in western urban China. PLoS One. 2013; 8(9): e73578.
- Barber SL, Borowitz M, Bekedam H, et al. The hospital of the future in China: China's reform of public hospitals and trends from industrialized countries. Health Policy Plan. 2014; 29(3): 367–378.
- Korda H, Itani Z. Harnessing social media for health promotion and behavior change. Health Promot Pract. 2013; 14(1): 15–23.
- Longde W, Ling Y, Yang H, et al. Fixed-dose combination treatment after stroke for secondary prevention in China: a national community-based study. Stroke. 2015; 46(5): 1295–1300.
- National Center for Stroke Control and Prevention, t.N.H.C. The China National Stroke screening survey guidelines 2016.
- Li S, Cui LY, Anderson C, et al. FAST-RIGHT Investigators and Coordinators. Public awareness of stroke and the appropriate responses in China: a cross-sectional community-based study (FAST-RIGHT). Stroke. 2019; 50(2): 455–462.
- Harbison J, Hossain O, Jenkinson D, et al. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003; 34(1): 71–76.
- Li S, Cui LY, Anderson C, et al. FAST-RIGHT Investigators and Coordinators. Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China. BMC Neurol. 2019; 19(1): 283.
- Li Y, Li C, Xu J, et al. Emergency department enlargement in China: exciting or bothering. J Thorac Dis. 2016; 8(5): 842–847.
- Zhang JF, Qiu MY, Zhang YL, et al. Neurology practice and stroke services across East China: a multi-site, county-level hospital-based survey. BMC Neurol. 2019; 19(1): 293.
- Liu X, Kong D, Lian H, et al. Distribution and predictors of hospital charges for haemorrhagic stroke patients in Beijing, China, March 2012 to February 2015: a retrospective study. BMJ Open. 2018; 8(3): e017693.
- Fiscella K. Relationships between income, health behaviors, and life expectancy. JAMA. 2016; 316(8): 880.
- Pickett KE, Wilkinson RG. Income inequality and health: a causal review. Soc Sci Med. 2015; 128: 316–326.
- Johnston DW, Lordan G, Shields MA, et al. Education and health knowledge: evidence from UK compulsory schooling reform. Soc Sci Med. 2015; 127: 92–100.
- Jiang B, Ru X, Sun H, et al. Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. Sci Rep. 2016; 6: 29795.
- Schneider AT, Pancioli AM, Khoury JC, et al. Trends in community knowledge of the warning signs and risk factors for stroke. JAMA. 2003; 289(3): 343–346.
- Teuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke. 2010; 5(3): 187–208.
- Nicol MB, Thrift AG. Knowledge of risk factors and warning signs of stroke. Vasc Health Risk Manag. 2005; 1(2): 137–147.
- Wang MD, Wang Y, Mao L, et al. Acute stroke patients' knowledge of stroke at discharge in China: a cross-sectional study. Trop Med Int Health. 2018; 23(11): 1200–1206.
- Yang J, Zheng M, Cheng S, et al. Knowledge of stroke symptoms and treatment among community residents in Western Urban China. J Stroke Cerebrovasc Dis. 2014; 23(5): 1216–1224.
- Fussman C, Rafferty AP, Lyon-Callo S, et al. Lack of association between stroke symptom knowledge and intent to call 911: a population-based survey. Stroke. 2010; 41(7): 1501–1507.
- Zhou Y, Yan S, Song X, et al. Intravenous thrombolytic therapy for acute ischemic stroke in Hubei, China: a survey of thrombolysis rate and barriers. BMC Neurol. 2019; 19(1): 202.
- Fassbender K, Balucani C, Walter S, et al. Streamlining of prehospital stroke management: the golden hour. Lancet Neurol. 2013; 12(6): 585–596.
- Rankin P, Marsh D, McLaughlin J. Abstract WP373: Emergency medical service stroke education in a rural community: need for improvement. Stroke. 2017; 48(Suppl 1).
- Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011; 42(12): 3651–3654.
- Wang YJ, Zhang SM, Zhang L, et al. Chinese guidelines for the secondary prevention of ischemic stroke and transient ischemic attack 2010. CNS Neurosci Ther. 2012; 18(2): 93–101.
- Kim YS, Park SS, Bae HJ, et al. Public awareness of stroke in Korea: a population-based national survey. Stroke. 2012; 43(4): 1146–1149.
- Bay JL, Spiroski AM, Fogg-Rogers L, et al. Stroke awareness and knowledge in an urban New Zealand population. J Stroke Cerebrovasc Dis. 2015; 24(6): 1153–1162.
- Li D, Zhou Z, Si Y, et al. Unequal distribution of health human resource in mainland China: what are the determinants from a comprehensive perspective? Int J Equity Health. 2018; 17(1): 29.
- Wu Na, Zhao S, Zhang Qi. A study on the determinants of private car ownership in China: findings from the panel data. Transportation Research Part A: Policy and Practice. 2016; 85: 186–195.
- Wu S, Wu Bo, Liu M, et al. China Stroke Study Collaboration. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019; 18(4): 394–405.
- Jiang B, Liang S, Peng ZR, et al. Transport and public health in China: the road to a healthy future. Lancet. 2017; 390(10104): 1781–1791.
- Jing Z, Renyu L. Calling for a rapid recognition and response program for stroke in China. Transl Perioper Pain Med. 2016; 1(4): 1–4.
- Sun H, Chen S, Jiang B, et al. Public knowledge of stroke in Chinese urban residents: a community questionnaire study. Neurol Res. 2011; 33(5): 536–540.
- Palafox B, McKee M, Balabanova D, et al. Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries. Int J Equity Health. 2016; 15(1): 199.
- Lyson HC, Le GM, Zhang J, et al. Social media as a tool to promote health awareness: results from an online cervical cancer prevention study. J Cancer Educ. 2019; 34(4): 819–822.
- Zhou Y, Yang T, Gong Y, et al. Pre-hospital delay after acute ischemic stroke in central urban China: prevalence and risk factors. Mol Neurobiol. 2017; 54(4): 3007–3016.
