Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/10690
Title: Improvements in the quality of care and health outcomes with new stroke care units following implementation of a clinician-led, health system redesign programme in New South Wales, Australia.
Authors: Cadilhac, Dominique A;Pearce, D C;Levi, Christopher R;Donnan, Geoffrey A
Institutional Author: Greater Metropolitan Clinical Taskforce and New South Wales Stroke Services Coordinating Committee
Affiliation: National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia. dcadilhac@nsri.org.au
Issue Date: 1-Oct-2008
Citation: Quality & Safety in Health Care; 17(5): 329-33
Abstract: Provision of evidence-based hospital stroke care is limited worldwide. In Australia, about a fifth of public hospitals provide stroke care units (SCUs). In 2001, the New South Wales (NSW) state government funded a clinician-led, health system redesign programme that included inpatient stroke services. Our objective was to determine the effects of this initiative for improving: (i) access to SCUs and care quality and (ii) health outcomes.Preintervention-postintervention design (12 months prior and a minimum 6-12 months following SCU implementation). Retrospective, public hospital audit of 50 consecutive medical records per time period of stroke admissions (using International Classification of Diseases (ICD)-10 codes). Combined analyses for 15 hospitals presented.Process of care indicators and patient independence (proportional odds modelling using modified Rankin scale).Pre-programme cases (n = 703) (mean (SD) age 74 (14) years; female: 51%) and post-programme cases (n = 884) (mean age 74 (14) years; female: 49%) were comparable. Significant post-programme improvements for most process indicators were found, such as more brain imaging within 24 hours. Post-programme, access to SCUs increased 22-fold (95% CI 16.8 to 28.3). Improvement in inpatient independence at post-programme discharge was significant compared with pre-programme outcomes (proportional odds ratio 0.73, 95% CI 0.57 to 0.94; p = 0.013) when adjusted for patient clustering and case mix.This distinctive SCU initiative was shown as effective for improving clinical practice and significantly reducing disability following stroke.
Internal ID Number: 18842970
URI: http://ahro.austin.org.au/austinjspui/handle/1/10690
DOI: 10.1136/qshc.2007.024604
URL: http://www.ncbi.nlm.nih.gov/pubmed/18842970
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Female
Health Plan Implementation
Health Services Accessibility.economics
Hospital Units.standards
Humans
Male
Medical Audit
Medical Records
New South Wales
Outcome and Process Assessment (Health Care)
Patient Admission
Program Evaluation
Quality Indicators, Health Care
Quality of Health Care
Retrospective Studies
Stroke.complications.therapy
Appears in Collections:Journal articles

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