Qual Saf Health Care 17:329-333 doi:10.1136/qshc.2007.024604
  • Original research

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

  1. D A Cadilhac1,2,
  2. D C Pearce1,
  3. C R Levi3,
  4. G A Donnan1,2,4
  1. 1
    National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia
  2. 2
    Department of Medicine, University of Melbourne, Melbourne, Australia
  3. 3
    Hunter Stroke Service, John Hunter Hospital, Newcastle, New South Wales, Australia
  4. 4
    Neurology Department, Austin Health, Heidelberg Heights, Victoria, Australia
  1. D A Cadilhac, National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia 3081; dcadilhac{at}
  • Accepted 12 November 2007


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.


  • Funding: The GMCT evaluation was supported by New South Wales Health, which was facilitated by the Greater Metropolitan Clinical Taskforce and the New South Wales Stroke Services Network Coordinating Committee.

  • Competing interests: CL is the head of one of the dedicated stroke units involved in this study. However, he was not directly involved in the collection of data or analysis of the results.