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.
Cadilhac
D A
DA
National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia. dcadilhac@nsri.org.au
Pearce
D C
DC
Levi
C R
CR
Donnan
G A
GA
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*