Quality of acute care and long-term quality of life and survival: the Australian stroke clinical registry

Cadilhac, Dominique A. , Andrew, Nadine E. , Lannin, Natasha A., Middleton, Sandy, Levi, Christopher R. , Dewey, Helen M., Grabsch, Brenda, Faux, Steve, Hill, Kelvin, Grimley, Rohan, Wong, Andrew, Sabet, Arman, Butler, Ernest, Bladin, Christopher F., Bates, Timothy R., Groot, Patrick, Castley, Helen, Donnan, Geoffrey A. and Anderson, Craig S. (2017) Quality of acute care and long-term quality of life and survival: the Australian stroke clinical registry. Stroke, 48 4: 1026-1032. doi:10.1161/STROKEAHA.116.015714


Author Cadilhac, Dominique A.
Andrew, Nadine E.
Lannin, Natasha A.
Middleton, Sandy
Levi, Christopher R.
Dewey, Helen M.
Grabsch, Brenda
Faux, Steve
Hill, Kelvin
Grimley, Rohan
Wong, Andrew
Sabet, Arman
Butler, Ernest
Bladin, Christopher F.
Bates, Timothy R.
Groot, Patrick
Castley, Helen
Donnan, Geoffrey A.
Anderson, Craig S.
Title Quality of acute care and long-term quality of life and survival: the Australian stroke clinical registry
Journal name Stroke   Check publisher's open access policy
ISSN 1524-4628
0039-2499
Publication date 2017-04-01
Sub-type Article (original research)
DOI 10.1161/STROKEAHA.116.015714
Open Access Status Not yet assessed
Volume 48
Issue 4
Start page 1026
End page 1032
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2018
Language eng
Formatted abstract
Background and Purpose: Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke.

Methods: Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received.

Results: There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%).

Conclusions: Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
Keyword Hospitals
Quality of health care
Quality of life
Stroke
Survival
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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