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Title: Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry.
Austin Authors: Cadilhac, Dominique A;Andrew, Nadine E;Lannin, Natasha A;Middleton, Sandy;Levi, Christopher R;Dewey, Helen M;Grabsch, Brenda;Faux, Steve;Hill, Kelvin;Grimley, Rohan;Wong, Andrew;Sabet, Arman;Butler, Ernest;Bladin, Christopher F;Bates, Timothy R;Groot, Patrick;Castley, Helen;Donnan, Geoffrey A ;Anderson, Craig S
Affiliation: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia
Nursing Research Institute, St Vincent's Health Australia, Sydney
Australian Catholic University, New South Wales
Priority Research Centre for Translational Neurosciences Mental Health Research, University of Newcastle
Hunter Research Institute, New South Wales, Australia
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
Faculty of Medicine, The University of New South Wales, Sydney
St Vincent's Hospital, Darlinghurst, Australia
National Stroke Foundation, Melbourne, Victoria, Australia
University of Queensland, Brisbane, Australia
Neurology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
Neurology Department, Gold Coast Hospital, Queensland, Australia
Neurology Department, Peninsula Health, Frankston, Victoria, Australia
Swan District Hospital and University of Western Australia, Perth, Australia
South West Healthcare, Warrnambool, Victoria, Australia
Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
The George Institute for Global Health, The University of Sydney, New South Wales, Australia
Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
Issue Date: Apr-2017 2017-03-03
Publication information: Stroke 2017; 48(4): 1026-1032
Abstract: Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%). Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
DOI: 10.1161/STROKEAHA.116.015714
ORCID: 0000-0001-8162-682X
PubMed URL: 28258253
Type: Journal Article
Subjects: hospitals
quality of health care
quality of life
Appears in Collections:Journal articles

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