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Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/38675

Title
Improvements in the quality of care and health outcomes with new stroke care units following implementation of a clinician-led, health system redesign programme in New South Wales, Australia
Author/Creator
Cadilhac, D. A.;  Pearce, D. C.;  Levi, C. R.;  Donnan, G. A.
Institution
The University of Newcastle. Faculty of Health, School of Medicine and Public Health
Description
Background and objectives: Provision of evidence-based hospital stroke care is limited worldwide. In Australia, about a fifth of public hospitals provide stroke care units (SCUs). In 2001, the New South Wales (NSW) state government funded a clinician-led, health system redesign programme that included inpatient stroke services. Our objective was to determine the effects of this initiative for improving: (i) access to SCUs and care quality and (ii) health outcomes.Design, setting and participants: Preintervention–postintervention design (12 months prior and a minimum 6–12 months following SCU implementation). Retrospective, public hospital audit of 50 consecutive medical records per time period of stroke admissions (using International Classification of Diseases (ICD)-10 codes). Combined analyses for 15 hospitals presented.Outcomes: Process of care indicators and patient independence (proportional odds modelling using modified Rankin scale).Results: Pre-programme cases (n = 703) (mean (SD) age 74 (14) years; female: 51%) and post-programme cases (n = 884) (mean age 74 (14) years; female: 49%) were comparable. Significant post-programme improvements for most process indicators were found, such as more brain imaging within 24 hours. Post-programme, access to SCUs increased 22-fold (95% CI 16.8 to 28.3). Improvement in inpatient independence at post-programme discharge was significant compared with pre-programme outcomes (proportional odds ratio 0.73, 95% CI 0.57 to 0.94; p = 0.013) when adjusted for patient clustering and case mix.Conclusions: This distinctive SCU initiative was shown as effective for improving clinical practice and significantly reducing disability following stroke.
Relation
Quality and Safety in Health Care Vol. 17, Issue 5, p. 329-333
Publisher Link
http://dx.doi.org/10.1136/qshc.2007.024604
Date
2008
Publisher
BMJ Publishing Group
Keyword(s)
stroke;  stroke care units;  disability;  health outomes
Resource Type
journal article
Identifier
http://hdl.handle.net/1959.13/38675
Identifier
ISSN:1475-3898
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Reviewed
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Subject
"Quality and Safety in Health Care"
 
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