Risk‐adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR)

Stroke is a leading cause of death and adult disability, worldwide. Variability in the care provided to patients admitted to hospital with acute stroke can affect their recovery and is inefficient.1,2 Most studies of the outcomes after hospital care have focused on survival, discharge destination, or disability in the short term. Research on the quality of hospital Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better healthrelated 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%). We aimed to determine the relationship between receiving combinations of 3 recommended processes of acute care in hospital (referred herein as quality indicators) and patient outcomes ≤180 days after the onset of stroke, assessing the differences by stroke type. Conclusions-Patients MethodsThe data were from 42 hospitals participating in the Australian Stroke Clinical Registry (AuSCR) between 2010 and 2014. Staff from participating hospitals enter the data prospectively using the online system. Information includes patient characteristics, quality indicators, and health outcome measures.9,10 Longer-term patient outcomes are obtained centrally by AuSCR staff using survey methods (eg, for HRQoL) or annual data linkage to national death registrations.Eligible patients were aged ≥18 years with a diagnosis of ischemic stroke, intracerebral hemorrhage (ICH), or stroke of undetermined cause recorded by clinicians in the AuSCR database. For this study, the preference was to use ...

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“…15 We also report deaths to 180 days for the first recorded admission (95%), since patients may have had more than one admission.…”

Section: Patient Outcomesmentioning

confidence: 99%

“…April 2017 admission (as a validated measure of stroke severity), 15,20 socioeconomic position, in-hospital stroke, and for correlations among patients within individual hospitals.…”

Section: Strokementioning

confidence: 99%

Quality of Acute Care and Long-Term Quality of Life and Survival

Cadilhac

Andrew

Lannin

et al. 2017

Stroke

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“…4 The Australian Stroke Clinical Registry (AuSCR) prospectively collected clinical data on 15 951 patients who were admitted with acute stroke to 28 participating Australian hospitals (18 metropolitan and 10 rural or regional), each of which provided at least 200 episodes of stroke care between 2009 and 2014. 4,5 Baseline AuSCR data included information routinely collected by hospitals (age, sex, country of birth, Indigenous status, socioeconomic status of postcode, year of stroke, stroke type) as well as additional prognostic covariates (a history of previous stroke; ability to walk on admission). The AuSCR data were linked to 2372 national death registrations, realising an overall crude 30-day mortality rate of 14.6%.…”

mentioning

confidence: 99%

“…The crude 30-day mortality rate ranged between 5.2% and 19.6%, despite similar adherence to evidencebased processes of care in the 28 hospitals (such as treating patients in stroke units). 4 Patients who died as the result of their stroke within 30 days of hospitalisation were, on average, older than 30-day survivors, and were more frequently women, unable to walk on admission, and hospitalised for a haemorrhagic or recurrent stroke. After adjusting for prognostic covariates recorded in hospital admission data, the 30-day risk-adjusted mortality rate (RAMR) ranged from 8% to 20% across the 28 hospitals.…”

mentioning

confidence: 99%

“…The models with the best fit were those that included stroke severity, as indicated by ability to walk on admission, as a covariate; data for this factor are currently recorded only in the AuSCR. 4 The authors of the AuSCR study are to be congratulated for overcoming challenges to obtaining data held by the states (hospital data) and by the National Death Index for linkage to a non-governmental national clinical registry, the AuSCR. Their study illustrates the importance of adjusting analyses for key baseline variables (such as stroke severity) when comparing mortality rates for patients hospitalised for stroke.…”

mentioning

confidence: 99%

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