RT Journal Article
SR Electronic
T1 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
JF Quality and Safety in Health Care
JO Qual Saf Health Care
FD BMJ Publishing Group Ltd
SP 329
OP 333
DO 10.1136/qshc.2007.024604
VO 17
IS 5
A1 D A Cadilhac
A1 D C Pearce
A1 C R Levi
A1 G A Donnan
YR 2008
UL http://qualitysafety.bmj.com/content/17/5/329.abstract
AB 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.