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
- 1National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia
- 2Department of Medicine, University of Melbourne, Melbourne, Australia
- 3Hunter Stroke Service, John Hunter Hospital, Newcastle, New South Wales, Australia
- 4Neurology Department, Austin Health, Heidelberg Heights, Victoria, Australia
- D A Cadilhac, National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia 3081;
- 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.