Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/11056
Title: Metropolitan-rural divide for stroke outcomes: do stroke units make a difference?
Authors: Cadilhac, Dominique A;Kilkenny, Monique F;Longworth, M;Pollack, M R P;Levi, Christopher R
Institutional Author: Metropolitan Clinical Taskforce and Stroke Services New South Wales Coordinating Committee
Affiliation: National Stroke Research Institute, Florey Neuroscience Institutes, Melbourne Brain Centre, Austin Health, 245 Burgundy St, Heidelberg, VIC 3084, Australia. cadilhac@unimelb.edu.au
Issue Date: 1-Apr-2011
Citation: Internal Medicine Journal; 41(4): 321-6
Abstract:   Stroke care across Australian hospitals is variable. The impact on health outcomes, in particular levels of disability for patients in rural areas, is unclear. The aim of this study was to determine whether geographic location and access to stroke units are associated with differences in health outcomes in patients with acute stroke.  Retrospective cohort study of consecutive eligible admissions from 32 hospitals (12 rural) in New South Wales between 2003 and 2007. Health status measured at discharge included level of independence (modified Rankin score: mRS) and frequency of severe complications during hospitalization. Multivariable analyses included adjustment for patient casemix and clustering.  Among 2254 eligible patients, 55% were treated in metropolitan hospitals. Stroke unit treatment varied significantly (rural 3%; metropolitan 77%). Age, gender and stroke type did not differ by location (mean age 74, 50% female). After adjusting for age, gender, ethnicity, important risk factors and validated stroke prognostic variables, patients treated in rural hospitals had a greater odds of dying during hospitalization compared with those treated in metropolitan hospitals (adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI) 1.03-2.05). There were no differences in mortality or frequency of severe complications between patients treated in rural and metropolitan hospitals when we adjusted for access to stroke units (aOR 1.00, 95% CI 0.62-1.61). Nevertheless, patients treated in rural hospitals were more dependent (mRS 3-5) at discharge (aOR 1.82, 95% CI 1.23-2.70) despite adjusting for stroke unit status.  Patients with stroke treated in rural hospitals have poorer health outcomes, especially if not managed in stroke units.
Internal ID Number: 20546059
URI: http://ahro.austin.org.au/austinjspui/handle/1/11056
DOI: 10.1111/j.1445-5994.2010.02280.x
URL: http://www.ncbi.nlm.nih.gov/pubmed/20546059
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Cohort Studies
Female
Hospital Mortality.trends
Hospitalization.trends
Hospitals, Rural.standards.trends
Hospitals, Urban.standards.trends
Humans
Male
Middle Aged
New South Wales.epidemiology
Patient Discharge.standards.trends
Retrospective Studies
Risk Factors
Stroke.diagnosis.mortality.therapy
Treatment Outcome
Appears in Collections:Journal articles

Files in This Item:
There are no files associated with this item.


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.