Quality of care for urinary incontinence in a rehabilitation setting for patients with stroke. Simultaneous monitoring of process and outcome

Abstract

Objective. To study the quality of care provided for patients with urinary incontinence following a stroke, by monitoring both process and outcome elements of care simultaneously. Design. Prospective follow-up of patients (of all ages and of both sexes) with urinary incontinence that appeared following a stroke who were admitted for rehabilitation during a six 6-month period. Setting. A ward for stroke rehabilitation in The Loewenstein Hospital-Rehabilitation Centre in Raanana, Israel. Results. Thirty-seven patients with stroke and urinary incontinence (mean age 61 years, 68% men) were included in the study; 84% of the 37 patients were discharged, although only 25% of them were continent. No lasting complications of urinary incontinence developed and there was no interference with rehabilitation activities. There was a correlation between incontinence and low score of Functional Independence Measure (FIM) on admission, being higher on discharge in those who became continent than in those who did not. Conclusions. Ward staff are aware of the potential problem of incontinence in patients with stroke. The problem is identified on admission and accorded adequate attention and care with satisfactory outcomes. The approach of monitoring process and outcome elements of care simultaneously in conditions that, during inpatient rehabilitation of patients with stroke, may endanger life, interfere with rehabilitation and delay functional recovery, could be a useful way to assess and improve the quality of care.