Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22509
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dc.contributor.authorCadilhac, Dominique A-
dc.contributor.authorGrimley, Rohan-
dc.contributor.authorKilkenny, Monique F-
dc.contributor.authorAndrew, Nadine E-
dc.contributor.authorLannin, Natasha A-
dc.contributor.authorHill, Kelvin-
dc.contributor.authorGrabsch, Brenda-
dc.contributor.authorLevi, Christopher R-
dc.contributor.authorThrift, Amanda G-
dc.contributor.authorFaux, Steven G-
dc.contributor.authorWakefield, John-
dc.contributor.authorCadigan, Greg-
dc.contributor.authorDonnan, Geoffrey A-
dc.contributor.authorMiddleton, Sandy-
dc.contributor.authorAnderson, Craig S-
dc.date2019-
dc.date.accessioned2020-01-29T02:51:28Z-
dc.date.available2020-01-29T02:51:28Z-
dc.date.issued2019-
dc.identifier.citationStroke 2019; 50(6): 1525-1530-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/22509-
dc.description.abstractBackground 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.-
dc.language.isoeng-
dc.subjecthealth services-
dc.subjecthistorically controlled study-
dc.subjecthumans-
dc.subjectquality of health care-
dc.subjectreimbursement, incentive-
dc.subjectStroke-
dc.titleMulticenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care.-
dc.typeJournal Article-
dc.identifier.journaltitleStroke-
dc.identifier.affiliationClinical Excellence Division, Queensland Health, Brisbane, Australiaen
dc.identifier.affiliationThe George Institute China at Peking University Health Science Center, Beijing, PR Chinaen
dc.identifier.affiliationUniversity of New South Wales, Sydney, Australiaen
dc.identifier.affiliationDepartment of Rehabilitation Medicine, St. Vincent's Health Australia (Sydney), New South Walesen
dc.identifier.affiliationCollege of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australiaen
dc.identifier.affiliationOccupational Therapy Department, Alfred Health, Prahran, Victoria, Australiaen
dc.identifier.affiliationStroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australiaen
dc.identifier.affiliationDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australiaen
dc.identifier.affiliationStroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australiaen
dc.identifier.affiliationSunshine Coast Clinical School, The University of Queensland, Birtinya, Australiaen
dc.identifier.affiliationGeorge Institute for Global Health, University of New South Wales, Sydney, Australiaen
dc.identifier.affiliationClinical Services, Stroke Foundation, Melbourne, Victoria, Australia-
dc.identifier.affiliationStroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia-
dc.identifier.affiliationUniversity of New South Wales, Sydney, Australia-
dc.identifier.affiliationClinical Excellence Division, Queensland Health, Brisbane, Australia-
dc.identifier.affiliationNursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia-
dc.identifier.doi10.1161/STROKEAHA.118.023075-
dc.identifier.orcid0000-0002-3375-287Xen
dc.identifier.orcid0000-0001-8162-682Xen
dc.identifier.pubmedid31084337-
dc.type.austinClinical Trial-
dc.type.austinComparative Study-
dc.type.austinJournal Article-
dc.type.austinMulticenter Study-
dc.type.austinResearch Support, Non-U.S. Gov't-
local.name.researcherDonnan, Geoffrey A
item.openairetypeJournal Article-
item.cerifentitytypePublications-
item.grantfulltextnone-
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.languageiso639-1en-
crisitem.author.deptThe Florey Institute of Neuroscience and Mental Health-
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