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Title: Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals?
Austin Authors: Cadilhac, Dominique A;Purvis, Tara;Kilkenny, Monique F;Longworth, Mark;Mohr, Katherine;Pollack, Michael;Levi, Christopher R
Institutional Author: New South Wales Strokes Services Coordinating Commitee
Agency for Clinical Innovation
Affiliation: From the Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Southern Clinical School, Monash University, Clayton, Australia (D.A.C., T.P., M.K.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Australia (D.A.C., T.P., M.K.); Stroke Services New South Wales, New South Wales Agency for Clinical Innovation, New South Wales, Australia (M.L.); Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia (K.M.); Hunter Stroke Service, Hunter New England Area Health, Rankin Park Centre, New South Wales, Australia (M.P.); Centre for Brain and Mental Health Research, University of Newcastle and Hunter Medical Research Institute, New Lambton, New South Wales, Australia (C.L.); and John Hunter Hospital, Newcastle, New South Wales, Australia (C.L.).
Issue Date: 15-Aug-2013
Publication information: Stroke; A Journal of Cerebral Circulation 2013; 44(10): 2848-53
Abstract: The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes.A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented.pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P<0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P<0.001); use of care plans (pre 15%; post 63%, P<0.001); and allied health assessments within 48 hours (pre 65%; post 82% P<0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34-2.66).Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.
Gov't Doc #: 23950561
DOI: 10.1161/STROKEAHA.113.001258
Journal: Stroke
Type: Journal Article
Subjects: coordinator
stroke care
stroke delivery
stroke units
Clinical Audit
Delivery of Health Care.organization & administration.standards.trends
Efficiency, Organizational.standards.trends
Guidelines as Topic
Hospitals, Special.organization & administration.standards.trends
New South Wales
Retrospective Studies
Rural Health Services.organization & administration.standards.trends
Appears in Collections:Journal articles

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