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dc.contributor.authorCadilhac, Dominique Aen
dc.contributor.authorPearce, D Cen
dc.contributor.authorLevi, Christopher Ren
dc.contributor.authorDonnan, Geoffrey Aen
dc.date.accessioned2015-05-16T00:13:24Z
dc.date.available2015-05-16T00:13:24Z
dc.date.issued2008-10-01en
dc.identifier.citationQuality & Safety in Health Care; 17(5): 329-33en
dc.identifier.govdoc18842970en
dc.identifier.otherPUBMEDen
dc.identifier.urihttp://ahro.austin.org.au/austinjspui/handle/1/10690en
dc.description.abstractProvision 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.en
dc.language.isoenen
dc.subject.otherAgeden
dc.subject.otherAged, 80 and overen
dc.subject.otherFemaleen
dc.subject.otherHealth Plan Implementationen
dc.subject.otherHealth Services Accessibility.economicsen
dc.subject.otherHospital Units.standardsen
dc.subject.otherHumansen
dc.subject.otherMaleen
dc.subject.otherMedical Auditen
dc.subject.otherMedical Recordsen
dc.subject.otherNew South Walesen
dc.subject.otherOutcome and Process Assessment (Health Care)en
dc.subject.otherPatient Admissionen
dc.subject.otherProgram Evaluationen
dc.subject.otherQuality Indicators, Health Careen
dc.subject.otherQuality of Health Careen
dc.subject.otherRetrospective Studiesen
dc.subject.otherStroke.complications.therapyen
dc.titleImprovements 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.en
dc.typeJournal Articleen
dc.identifier.journaltitleQuality & safety in health careen
dc.identifier.affiliationdcadilhac@nsri.org.auen
dc.identifier.affiliationNational Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australiaen
dc.identifier.doi10.1136/qshc.2007.024604en
dc.description.pages329-33en
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/18842970en
dc.contributor.corpauthorGreater Metropolitan Clinical Taskforce and New South Wales Stroke Services Coordinating Committeeen
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