Multicenter comparison of processes of care between Stroke Units and conventional care wards in Australia.
OBJECTIVE
Approximately 23% of Australian hospitals provide Stroke Units (SUs). Evidence suggests that clinical outcomes are better in SUs than with conventional care. Reasons may include greater adherence to processes of care (PoC). The primary hypothesis was that adherence to selected PoC is greater in SUs than in other acute care models.


METHODS
Prospective, multicenter, single-blinded design. Models of care investigated: SUs, mobile services, and conventional care. Selected PoC were related to care models and participant outcomes. Data were collected at acute hospitalization (median 9 days) and at medians of 8 and 28 weeks after stroke.


RESULTS
1701 patients were screened from 8 hospitals, 823 were eligible, and 468 participated. Response rate was 96% at final follow-up. Mean age was 73 years (SD 14). Overall PoC adherence rates for individual care models were SU 75%, mobile service 65%, and conventional care 52% (P<0.001). The adjusted odds of participants being alive at discharge if adhering to all or all but 1 PoC was significant (aOR 3.63; 95% CI: 1.04 to 12.66; P=0.043). Important trends at 28 weeks were found for being at home (aOR 3.09; 95% CI: 0.96 to 9.87; P=0.058) and independent (aOR 2.61; 95% CI: 0.96 to 7.10; P=0.061), with complete PoC adherence.


CONCLUSIONS
Adherence to key PoC was higher in SUs than in other models. For all patients, adherence to PoC was associated with improved mortality at discharge and trends found with independence at home, providing support for the need to increase access to stroke units.
Cadilhac
Dominique A
DA
National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia 3081. cadilhac@austin.unimelb.edu.au
Ibrahim
Joeseph
J
Pearce
Dora C
DC
Ogden
Kathryn J
KJ
McNeill
John
J
Davis
Stephen M
SM
Donnan
Geoffrey A
GA
D000368:Aged; D001315:Australia / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010362:Patients' Rooms / Q000458:organization & administration*; D011446:Prospective Studies; D011787:Quality of Health Care; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*