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.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.
National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia. dcadilhac@nsri.org.au
D A
DA
Cadilhac
D C
DC
Pearce
C R
CR
Levi
G A
GA
Donnan
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006284:Health Plan Implementation; D006297:Health Services Accessibility / Q000191:economics; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000628:therapy*