- 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
- Creator
- Cadilhac, D. A.; Pearce, D. C.; Levi, C. R.; Donnan, G. A.
- 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
- Publisher
- BMJ Publishing Group
- Resource Type
- journal article
- Date
- 2008
- 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.
- Subject
- stroke; stroke care units; disability; health outomes
- Identifier
- http://hdl.handle.net/1959.13/38675
- Identifier
- uon:4343
- Identifier
- ISSN:1475-3898
- Language
- eng
- Full Text
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