Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry

Dominique A. Cadilhac, Nadine E. Andrew, Natasha A. Lannin, Sandy Middleton, Christopher R. Levi, Helen M. Dewey, Brenda Grabsch, Steve Faux, Kelvin Hill, Rohan Grimley, Andrew Wong, Arman Sabet, Ernest Butler, Christopher F. Bladin, Timothy R. Bates, Patrick Groot, Helen Castley, Geoffrey A. Donnan, Craig S. Anderson

Research output: Contribution to journalArticle

27 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1026-1032
Number of pages7
JournalStroke
Volume48
Issue number4
DOIs
Publication statusPublished - 1 Apr 2017
Externally publishedYes

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