Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia

Purvis, Tara; Moss, Karen; Francis, Linda E.; Borschmann, Karen; Kilkenny, Monique F; Denisenko, Sonia; Bladin, Christopher; Cadilhac, Dominique A.

doi:10.1111/imj.13458

Cited by 10 publications

(17 citation statements)

References 18 publications

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“…At each participating hospital the medical records of up to 40 consecutive patients admitted with a primary diagnosis of stroke are retrospectively audited for patient demographic information, adherence to recommended processes of care and hospital-based patient outcomes [15]. These data were used to identify priority hospitals requiring support to improve adherence to clinical processes of care [13].…”

Section: Methodsmentioning

confidence: 99%

“…In our previous work we determined that the fixed-term employment of facilitators was effective in positively influencing stroke care in hospitals (e.g. more patients receiving brain imaging within 24 h, greater access to care in a stroke unit and intravenous thrombolysis if an ischaemic stroke) [13]. It remains unknown if there are broader benefits to hospitals associated with facilitator programs.…”

Section: Introductionmentioning

confidence: 99%

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Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

Cadilhac

Dewey

Denisenko

et al. 2019

BMC Health Serv Res

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BackgroundHospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care. Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program.MethodsObservational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006–07) and post-program (2010–11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons.ResultsA 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age > 75 years: 53%) and 3142 post-program (age > 75 years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3 days to post-program 5.7 days, p < 0.001). Six hospitals provided cost data. Average per-episode costs decreased by 10% (pre-program AUD7888 to post-program AUD7115). After adjusting for age, sex, stroke type, and hospital, average per-episode costs decreased by 6.1% from pre to post program (p = 0.025). When length of stay was additionally adjusted for, these costs increased by 10.8%, indicating a greater mean cost per day (p < 0.001).ConclusionCost containment of acute inpatient episodes was observed after the implementation of stroke clinical facilitators, likely associated with the shorter lengths of stay.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3836-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

Cadilhac

Dewey

Denisenko

et al. 2019

BMC Health Serv Res

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“…Based on the reliable feedback, regular individualized education would further improve the adherence to guideline-based care [23,24]. By providing the participating hospitals with improvement consultation, workshops, and webinars based on guidelines, GWTG-Stroke program achieved significant improvement of composite measure of care from 83.53 to 93.97% [25].…”

Section: Discussionmentioning

confidence: 99%

Rationale and design of individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE): a multicenter historically controlled study

Zhong

Gong

et al. 2020

Trials

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Background: Guideline-based medical care has been identified to improve outcomes in stroke. However, data acquisition and medical quality management during hospital stay still need to be improved in China. We have developed a computer-based medical data collecting system, together with automated calculation of key performance indicators (KPIs) and regular individualized education, and thus aim to explore whether it can improve the medical care quality of acute ischemic stroke (AIS) during hospital stay in stroke centers. Methods: The individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE) trial is a prospective, multicenter, historical control study among 30 stroke centers in China. In this trial, the data is directly extracted from the saved original medical record of each AIS patient during hospital stay, regardless of different Electronic Medical Record System (EMRS) in each center. Then, the automated calculation of KPIs and the regular education via teleconference per month allow the clinicians to examine the causes of non-compliance of guideline-based care and develop programs to decrease their frequency. Discussion: We compare KPIs between pre-intervention stage and post-intervention stage (without or with education) among stroke centers. If proved effective, this approach might be generalized around China and even worldwide, where a unified EMRS is difficult to be applied and in-patient care needs to be improved. Trial registration: ClinicalTrials.gov NCT03684629. Registered on 9 December 2018. Retrospectively registered.

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“…Based on the reliable feedback, regular individualized education would further improve the adherence to guideline-based care (23,24). By providing the participating hospitals with improvement consultation, workshops, and webinars based on guidelines, GWTG-Stroke program achieved signi cant improvement of composite measure of care from 83.53% to 93.97% (25) .…”

Section: Discussionmentioning

confidence: 99%

Rationale and design of individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE): a multicentre historically controlled study

Chen

Zhong

Gong

et al. 2020

Preprint

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Background: Guideline-based medical care has been identified to improve outcomes in stroke. However, data acquisition and medical quality management during hospital stay still need to be improved in China. We have developed a computer-based medical data collecting system, together with automated calculation of Key Performance Indicators (KPIs) and regular individualized education, and thus aim to explore whether it can improve the medical care quality of acute ischemic stroke (AIS) during hospital stay in stroke centers.Methods: The individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE) trial is a prospective, multi-center, historical control study among 30 stroke centers in China. In this trial, the data is directly extracted from the saved original medical record of each AIS patient during hospital stay, regardless of different Electronic Medical Record System (EMRS) in each center. Then the automated calculation of KPIs and the regular education via tele-conference per month allows the clinicians to examine the causes of non-compliance of guideline-based care and develop programs to decrease their frequency. Discussion: We compare KPIs between pre-intervention stage and post-intervention stage (without or with education) among stroke centers. If proved effective, this approach might be generalized around China and even worldwide, where a unified EMRS is difficult to be applied and in-patient care needs to be improved.Trial registration: clinicaltrials.gov, ID: NCT03684629. Registered on 9 December 2018. Retrospectively registered.

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Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia

Abstract: Fixed-term employment of Facilitators was effective in positively influencing stroke care in hospitals through a range of change management strategies where stroke-specific expertise had been previously limited.

Cited by 10 publications

References 18 publications

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

Rationale and design of individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE): a multicenter historically controlled study

Rationale and design of individualized quality improvement based on the Computer Analysing system to improve Stroke management quality Evaluation (CASE): a multicentre historically controlled study

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