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Title: Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care.
Austin Authors: Cadilhac, Dominique A;Grimley, Rohan;Kilkenny, Monique F;Andrew, Nadine E;Lannin, Natasha A;Hill, Kelvin;Grabsch, Brenda;Levi, Christopher R;Thrift, Amanda G;Faux, Steven G;Wakefield, John;Cadigan, Greg;Donnan, Geoffrey A ;Middleton, Sandy;Anderson, Craig S
Affiliation: Clinical Excellence Division, Queensland Health, Brisbane, Australia
The George Institute China at Peking University Health Science Center, Beijing, PR China
University of New South Wales, Sydney, Australia
Department of Rehabilitation Medicine, St. Vincent's Health Australia (Sydney), New South Wales
College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia
George Institute for Global Health, University of New South Wales, Sydney, Australia
Clinical Services, Stroke Foundation, Melbourne, Victoria, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia
University of New South Wales, Sydney, Australia
Clinical Excellence Division, Queensland Health, Brisbane, Australia
Nursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia
Issue Date: 2019
Date: 2019
Publication information: Stroke 2019; 50(6): 1525-1530
Abstract: Background and Purpose- Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods- A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results- There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%-24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%-20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%-17%). The national score (4 indicators) improved by 17% (95% CI, 13%-20%) versus 0% change in other Australian hospitals (95% CI, -0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals ( P<0.001). Conclusions- The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.
DOI: 10.1161/STROKEAHA.118.023075
ORCID: 0000-0002-3375-287X
Journal: Stroke
PubMed URL: 31084337
Type: Journal Article
Subjects: health services
historically controlled study
quality of health care
reimbursement, incentive
Appears in Collections:Journal articles

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