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Hancock SL, Purvis T, Thayabaranathan T, Stolwyk R, Cameron J, Dalli LL, Reyneke M, Kilkenny MF, Hill K, Cadilhac DA. Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals. Clin Rehabil 2024; 38:811-823. [PMID: 38385341 PMCID: PMC11059847 DOI: 10.1177/02692155241232990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Post-stroke mental health impairments are common, but under-assessed and under-treated. We aim to describe trends in the provision of mood management to patients with stroke, and describe factors associated with adoption of national mood management recommendations for stroke within Australian hospitals. DESIGN Secondary analysis of cross-sectional data from the biennial Stroke Foundation Audit Program. SETTING Participating acute (2011-2021) and rehabilitation hospitals (2012-2020) in Australia. PARTICIPANTS In the acute audit, 22,937 stroke cases were included from 133 hospitals. In the rehabilitation audit, 15,891 stroke cases were included from 127 hospitals. MAIN MEASURES Hospital- and patient-level mood management processes. RESULTS Among 133 acute hospitals (22,937 stroke episodes), improvements were made between 2011 and 2021 in utilization of mood screening (17% [2011], 33% [2021]; p < 0.001) and access to psychologists during hospital stay (18% [2011], 45% [2021]; p < 0.001). There was no change in access to a psychologist among those with a mood impairment (p = 0.34). Among 127 rehabilitation hospitals (15,891 stroke episodes) improvements were observed for mood screening (35% [2012], 61% [2020]; p < 0.001), and access to a psychologist during hospital stay (38% [2012], 68% [2020]; p < 0.001) and among those with a mood-impairment (30% [2012], 50% [2020]; p < 0.001). Factors associated with receiving mood management processes included: younger age, not requiring an interpreter and longer length of stay. CONCLUSIONS Adherence to mood management recommendations has improved over 10 years within Australian hospitals. Those aged over 65, requiring an interpreter, or with shorter hospital stays are at risk of missing out on appropriate mood management.
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Affiliation(s)
- Shaun L Hancock
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tara Purvis
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jan Cameron
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Megan Reyneke
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Mellahn K, Kilkenny M, Siyambalapitiya S, Lakhani A, Purvis T, Reyneke M, Cadilhac DA, Rose ML. Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter. Top Stroke Rehabil 2023:1-10. [PMID: 38116813 DOI: 10.1080/10749357.2023.2295128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND People with communication differences are known to have poorer hospital outcomes than their peers. However, the combined impact of aphasia and cultural/linguistic differences on care and outcomes after stroke remains unknown. OBJECTIVES To investigate the association between cultural/linguistic differences, defined as those requiring an interpreter, and the provision of acute evidence-based stroke care and in-hospital outcomes for people with aphasia. METHODS Cross-sectional, observational data collected in the Stroke Foundation National Audit of Acute Services (2017, 2019, 2021) were used. Multivariable regression models compared evidence-based care and in-hospital outcomes (e.g., length of stay) by interpreter status. Models were adjusted for sex, hospital location, stroke type and severity, with clustering by hospital. RESULTS Among 3122 people with aphasia (median age 78, 49% female) from 126 hospitals, 193 (6%) required an interpreter (median age 78, 55% female). Compared to people with aphasia not requiring an interpreter, those requiring an interpreter had similar care access but less often had their mood assessed (OR 0.50, 95% CI 0.32, 0.76), were more likely to have physiotherapy assessments (96% vs 90% p = 0.011) and carer training (OR 4.83, 95% CI 1.70, 13.70), had a 2 day longer median length of stay (8 days vs 6 days, p = 0.003), and were less likely to be independent on discharge (OR 0.54, 95% CI 0.33, 0.89). CONCLUSIONS Some differences exist in the management and outcomes for people with post-stroke aphasia who require an interpreter. Further research to explore their needs and the practical issues underpinning their clinical care pathways is required.
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Affiliation(s)
- Kathleen Mellahn
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Monique Kilkenny
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | | | - Ali Lakhani
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Megan Reyneke
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Miranda L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Bundoora, Australia
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
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Dalli LL, Burns C, Kilkenny MF, Gall SL, Hou WH, Hoffmann TC, Olaiya MT, Cameron J, Purvis T, Thrift AG, Nelson MR, Sanders A, Viney K, Phan HT, Freak-Poli R. In Search of a Gold Standard Tool for Assessing Knowledge of Stroke: A Systematic Review. Neuroepidemiology 2023; 58:75-91. [PMID: 37980894 DOI: 10.1159/000535292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Knowledge of stroke is essential to empower people to reduce their risk of these events. However, valid tools are required for accurate and reliable measurement of stroke knowledge. We aimed to systematically review contemporary stroke knowledge assessment tools and appraise their content validity, feasibility, and measurement properties. METHODS The protocol was registered in PROSPERO (CRD42023403566). Electronic databases (MEDLINE, PsycInfo, CINAHL, Embase, Scopus, Web of Science) were searched to identify published articles (1 January 2015-1 March 2023), in which stroke knowledge was assessed using a validated tool. Two reviewers independently screened titles and abstracts prior to undertaking full-text review. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods guided the appraisal of content validity (relevance, comprehensiveness, comprehensibility), feasibility, and measurement properties. RESULTS After removing duplicates, the titles and abstracts of 718 articles were screened; 323 reviewed in full; with 42 included (N = 23 unique stroke knowledge tools). For content validity, all tools were relevant, two were comprehensive, and seven were comprehensible. Validation metrics were reported for internal consistency (n = 20 tools), construct validity (n = 17 tools), cross-cultural validity (n = 15 tools), responsiveness (n = 9 tools), reliability (n = 7 tools), structural validity (n = 3 tools), and measurement error (n = 1 tool). The Stroke Knowledge Test met all content validity criteria, with validation data for six measurement properties (n = 3 rated "Sufficient"). CONCLUSION Assessment of stroke knowledge is not standardised and many tools lacked validated content or measurement properties. The Stroke Knowledge Test was the most comprehensive but requires updating and further validation for endorsement as a gold standard.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Catherine Burns
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Seana L Gall
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital/Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kayla Viney
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rosanne Freak-Poli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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4
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Purvis T, Cadilhac DA, Hill K, Reyneke M, Olaiya MT, Dalli LL, Kim J, Murphy L, Campbell BC, Kilkenny MF. Twenty years of monitoring acute stroke care in Australia through the national stroke audit programme (1999-2019): A cross-sectional study. J Health Serv Res Policy 2023; 28:252-261. [PMID: 37212454 DOI: 10.1177/13558196231174732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND National organisational surveys and clinical audits to monitor and guide improvements to the delivery of evidence-based acute stroke care have been undertaken in Australia since 1999. This study aimed to determine the association between repeated national audit cycles on stroke service provision and care delivery from 1999 to 2019. METHODS Cross-sectional study using data from organisational surveys (1999, 2004, 2007-2019) and clinical data from the biennial National Stroke Acute Audit (2007-2019). Age-, sex-, and stroke severity-adjusted proportions were reported for adherence to guideline-recommended care processes. Multivariable, logistic regression models were performed to determine the association between repeated audit cycles and service provision (organisational) and care delivery (clinical). RESULTS Overall, 197 hospitals provided organisational survey data (1999-2019), with 24,996 clinical cases from 136 hospitals (around 40 cases per audit) (2007-2019). We found significant improvements in service organisation between 1999 and 2019 for access to stroke units (1999: 42%, 2019: 81%), thrombolysis services (1999: 6%, 2019: 85%), and rapid assessment/management for patients with transient ischaemic attack (1999: 11%, 2019: 61%). Analyses of patient-level audits for 2007 to 2019 found the odds of receiving care processes per audit cycle to have significantly increased for thrombolysis (2007: 3%, 2019: 11%; OR 1.15, 95% CI 1.13, 1.17), stroke unit access (2007: 52%, 2019: 69%; OR 1.15, 95% CI 1.14, 1.17), risk factor advice (2007: 40%, 2019: 63%; OR 1.10, 95% CI 1.09, 1.12), and carer training (2007: 24%, 2019: 51%; OR 1.12, 95% CI 1.10, 1.15). CONCLUSIONS Between 1999 and 2019, the quality of acute stroke care in Australia has improved in line with best practice evidence. Standardised monitoring of stroke care can inform targeted efforts to reduce identified gaps in best practice, and illustrate the evolution of the health system for stroke.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Lisa Murphy
- Stroke Foundation, Melbourne, VIC, Australia
| | - Bruce Cv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Kilkenny MF, Sanders A, Burns C, Sanders LM, Ryan O, Read C, Lum On M, Ranta A, Purvis T, Inman C, Cadilhac DA, Carter H, Rowlands S, Nedkoff L, Olaiya MT. Stroke clinical coding education program in Australia and New Zealand. HEALTH INF MANAG J 2023:18333583231184004. [PMID: 37417466 DOI: 10.1177/18333583231184004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Accurate coded diagnostic data are important for epidemiological research of stroke. OBJECTIVE To develop, implement and evaluate an online education program for improving clinical coding of stroke. METHOD The Australia and New Zealand Stroke Coding Working Group co-developed an education program comprising eight modules: rationale for coding of stroke; understanding stroke; management of stroke; national coding standards; coding trees; good clinical documentation; coding practices; and scenarios. Clinical coders and health information managers participated in the 90-minute education program. Pre- and post-education surveys were administered to assess knowledge of stroke and coding, and to obtain feedback. Descriptive analyses were used for quantitative data, inductive thematic analysis for open-text responses, with all results triangulated. RESULTS Of 615 participants, 404 (66%) completed both pre- and post-education assessments. Respondents had improved knowledge for 9/12 questions (p < 0.05), including knowledge of applicable coding standards, coding of intracerebral haemorrhage and the actions to take when coding stroke (all p < 0.001). Majority of respondents agreed that information was pitched at an appropriate level; education materials were well organised; presenters had adequate knowledge; and that they would recommend the session to colleagues. In qualitative evaluations, the education program was beneficial for newly trained clinical coders, or as a knowledge refresher, and respondents valued clinical information from a stroke neurologist. CONCLUSION Our education program was associated with increased knowledge for clinical coding of stroke. To continue to address the quality of coded stroke data through improved stroke documentation, the next stage will be to adapt the educational program for clinicians.
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Affiliation(s)
- Monique F Kilkenny
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | | | | | - Lauren M Sanders
- St Vincent's Hospital Melbourne, Australia
- University of Melbourne, Australia
| | - Olivia Ryan
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | - Carla Read
- The Victorian Agency for Health Information, Australia
| | - Miriam Lum On
- Australian Institute of Health and Welfare, Australia
| | - Anna Ranta
- University of Otago-Wellington, New Zealand
| | | | | | - Dominique A Cadilhac
- Monash University, Australia
- The Florey Institute of Neuroscience and Mental Health, Australia
| | - Helen Carter
- The Florey Institute of Neuroscience and Mental Health, Australia
| | | | - Lee Nedkoff
- The University of Western Australia, Australia
- Victor Chang Cardiac Research Institute, Australia
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Bravata DM, Purvis T, Ding QP, Waddell KJ, Kilkenny MF. Advances in Stroke: Quality Improvement. Stroke 2023; 54:1665-1669. [PMID: 37051910 DOI: 10.1161/strokeaha.123.042310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Dawn M Bravata
- Department of Veterans Affairs, Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.)
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.)
- Regenstrief Institute, Indianapolis, IN (D.M.B.)
| | - Tara Purvis
- Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (T.P., M.F.K.)
| | | | - Kimberly J Waddell
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA (K.J.W.)
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.J.W.)
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia (K.J.W.)
| | - Monique F Kilkenny
- Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (T.P., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (M.F.K.)
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Bagot KL, Purvis T, Hancock S, Zhao H, Coote S, Easton D, Campbell BCV, Davis SM, Donnan GA, Foster S, Langenberg F, Smith K, Stephenson M, Bernard S, McGowan S, Yan B, Mitchell P, Middleton S, Cadilhac DA. Sustaining a New Model of Acute Stroke Care: A Mixed-Method Process Evaluation of the Melbourne Mobile Stroke Unit. Int J Health Policy Manag 2023; 12:7716. [PMID: 37579413 PMCID: PMC10461847 DOI: 10.34172/ijhpm.2023.7716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/21/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care. METHODS Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation. Participant purposive sampling included clinical, operational and executive/management representatives from Ambulance Victoria (AV) (emergency medical service provider), the MSU clinical team, and receiving hospitals. Sustainability was defined as ongoing MSU operations, including MSU workforce and future model considerations. Theoretically-based on-line survey with Unified Theory of Acceptance and Use of Technology (UTAUT), Self Determination Theory (SDT, Intrinsic Motivation), and open-text questions targeting barriers and benefits was administered (June-September 2019). Individual/group interviews were conducted, eliciting improvement suggestions and requirements for ongoing use. Descriptive and regression analyses (quantitative data) and directed content and thematic analysis (open text and interview data) were conducted. RESULTS There were 135 surveys completed. Identifying that the MSU was beneficial to daily work (β=0.61), not experiencing pressure/tension about working on the MSU (β=0.17) and thinking they did well working within the team model (β=0.17) were significantly associated with wanting to continue working within the MSU model [R2=0.76; F(15, 60)=12.76, P<.001]. Experiences varied between those on the MSU team and those working with the MSU. Advantages were identified for patients (better, faster care) and clinicians (interdisciplinary learning). Disadvantages included challenges integrating into established systems, and establishing working relationships. Themes identified from 35 interviews were MSU team composition, MSU vehicle design and layout, personnel recruitment and rostering, communication improvements between organisations, telemedicine options, MSU operations and dispatch specificity. CONCLUSION Important factors affecting the sustainability of the MSU model of stroke care emerged. A cohesive team approach, with identifiable benefits and good communication between participating organisations is important for clinical and operational sustainability.
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Affiliation(s)
- Kathleen L. Bagot
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Shaun Hancock
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
| | - Henry Zhao
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Ambulance Victoria, Melbourne, VIC, Australia
| | - Skye Coote
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Damien Easton
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Bruce CV Campbell
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Ambulance Victoria, Melbourne, VIC, Australia
- Stroke Foundation, Melbourne, VIC, Australia
| | - Stephen M. Davis
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Geoff A. Donnan
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Francesca Langenberg
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Ambulance Victoria, Melbourne, VIC, Australia
| | - Karen Smith
- Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Department of Paramedicine Monash University, Melbourne, Melbourne, VIC, Australia
- Discipline of Emergency Medicine, University of Western Australia, Perth, WA, Australia
| | - Michael Stephenson
- Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Department of Paramedicine Monash University, Melbourne, Melbourne, VIC, Australia
| | - Stephen Bernard
- Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Department of Paramedicine Monash University, Melbourne, Melbourne, VIC, Australia
| | | | - Bernard Yan
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Peter Mitchell
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sandy Middleton
- St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
- Nursing Research Institute, Australian Catholic University, Melbourne, VIC, Australia
| | - Dominique A. Cadilhac
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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8
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Bagot KL, Purvis T, Hancock S, Zhao H, Coote S, Easton D, Campbell BCV, Davis SM, Donnan GA, Foster S, Langenberg F, Smith K, Stephenson M, Bernard S, McGowan S, Yan B, Mitchell P, Middleton S, Cadilhac DA. Interdisciplinary interactions, social systems and technical infrastructure required for successful implementation of mobile stroke units: A qualitative process evaluation. J Eval Clin Pract 2023; 29:495-512. [PMID: 36648226 DOI: 10.1111/jep.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken. AIM To identify successes and challenges in the pre- and initial operations of the first Australian MSU service from an interdisciplinary perspective. METHODS Process evaluation of the Melbourne MSU with a mixed-methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June-September 2019) and semistructured interviews (October-November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework. RESULTS Participants representing executive/program operations, MSU clinicians and hospital-based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships. CONCLUSIONS Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments.
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Affiliation(s)
- Kathleen L Bagot
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Shaun Hancock
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Zhao
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Skye Coote
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Easton
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia.,Stroke Foundation, Melbourne, Victoria, Australia
| | - Steve M Davis
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff A Donnan
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Shane Foster
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Francesca Langenberg
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen Smith
- Ambulance Victoria, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.,Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Stephenson
- Ambulance Victoria, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Ambulance Victoria, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | | | - Bernard Yan
- Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Mitchell
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Sandy Middleton
- St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Nursing Research Institute, Australian Catholic University, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Public Health and Health Services Research, Stroke, The Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Melbourne, Victoria, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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9
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Gall SL, Feigin V, Thrift AG, Kleinig TJ, Cadilhac DA, Bennett DA, Nelson MR, Purvis T, Jalili-Moghaddam S, Kitsos G, Krishnamurthi R. Personalized knowledge to reduce the risk of stroke (PERKS-International): Protocol for a randomized controlled trial. Int J Stroke 2023; 18:477-483. [PMID: 35770887 DOI: 10.1177/17474930221113430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Theoretically, most strokes could be prevented through the management of modifiable risk factors. The Stroke Riskometer™ mobile phone application (hereon "The App") uses an individual's data to provide personalized information and advice to reduce their risk of stroke. AIMS To determine the effect of The App on a combined cardiovascular risk score (Life's Simple 7®, LS7) of modifiable risk factors at 6 months post-randomization. METHODS AND DESIGN PERKS-International is a Phase III, multicentre, prospective, pragmatic, open-label, single-blinded endpoint, two-arm randomized controlled trial (RCT). Inclusion criteria are as follows: age ⩾ 35 and ⩽75 years; ⩾2 LS7 risk factors; smartphone ownership; no history of stroke/myocardial infarction/cognitive impairment/terminal illness. The intervention group (IG) will be provided with The App, and the usual care group (UCG) is provided with generic online information about risk factors, but not be informed about The App. Face-to-face assessments will be conducted at baseline and 6 months, and online at 3 and 12 months. The RCT includes a process and economic evaluation. STUDY OUTCOMES AND SAMPLE SIZE The primary outcome is a difference in the mean change in LS7 (seven individual items: blood pressure, cholesterol, glucose, body mass index (BMI), smoking, physical activity, and diet) from baseline to 6 months post-randomization with intention-to-treat analysis. Secondary outcomes include: change in individual LS7 items, quality of life; stroke awareness, adverse events; health service use; and costs. Based on pilot data, 790 participants (395 IG, 395 UCG) will be required to provide 80% power (two-sided α = 0.05) to detect a mean difference in the LS7 of ⩾0.40 (SD 1.61) in IG compared to 0.01 (SD 1.44) in the UCG at 6 months post-randomization. DISCUSSION Stroke is largely preventable. This study will provide evidence of the effectiveness of a mobile app to reduce stroke risk. TRIAL REGISTRATION ACTRN12621000211864.
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Affiliation(s)
- Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- National Institute of Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery Feigin
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Amanda G Thrift
- National Institute of Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Timothy J Kleinig
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Shabnam Jalili-Moghaddam
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Gemma Kitsos
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Rita Krishnamurthi
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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10
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Purvis T, Cadilhac DA, Hill K, Gibbs AK, Ghuliani J, Middleton S, Kilkenny MF. Benefit of linking hospital resource information and patient-level stroke registry data. Int J Qual Health Care 2023; 35:7000243. [PMID: 36692013 PMCID: PMC9936789 DOI: 10.1093/intqhc/mzad003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Variation in the delivery of evidence-based care affects outcomes for patients with stroke. A range of hospital (organizational), patient, and clinical factors can affect care delivery. Clinical registries are widely used to monitor stroke care and guide quality improvement efforts within hospitals. However, hospital features are rarely collected. We aimed to explore the influence of hospital resources for stroke, in metropolitan and regional/rural hospitals, on the provision of evidence-based patient care and outcomes. The 2017 National Audit organizational survey (Australia) was linked to patient-level data from the Australian Stroke Clinical Registry (2016-2017 admissions). Regression models were used to assess the associations between hospital resources (based on the 2015 Australian National Acute Stroke Services Framework) and patient care (reflective of national guideline recommendations), as well as 90-180-day readmissions and health-related quality of life. Models were adjusted for patient factors, including the severity of stroke. Fifty-two out of 127 hospitals with organizational survey data were merged with 22 832 Australian Stroke Clinical Registry patients with an admission for a first-ever stroke or transient ischaemic attack (median age 75 years, 55% male, and 66% ischaemic). In metropolitan hospitals (n = 42, 20 977 patients, 1701 thrombolyzed, and 2395 readmitted between 90 and 180 days post stroke), a faster median door-to-needle time for thrombolysis was associated with ≥500 annual stroke admissions [-15.9 minutes, 95% confidence interval (CI) -27.2, -4.7], annual thrombolysis >20 patients (-20.2 minutes, 95% CI -32.0, -8.3), and having specialist stroke staff (dedicated medical lead and stroke coordinator; -12.7 minutes, 95% CI -25.0, -0.4). A reduced likelihood of all-cause readmissions between 90 and 180 days was evident in metropolitan hospitals using care pathways for stroke management (odds ratio 0.82, 95% CI 0.67-0.99). In regional/rural hospitals (n = 10, 1855 patients), being discharged with a care plan was also associated with the use of stroke clinical pathways (odds ratio 3.58, 95% CI 1.45-8.82). No specific hospital resources influenced 90-180-day health-related quality of life. Relevant to all international registries, integrating information about hospital resources with clinical registry data provides greater insights into factors that influence evidence-based care.
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Affiliation(s)
- Tara Purvis
- *Corresponding author. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, Victoria 3168, Australia. E-mail:
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Wright Street, Clayton, Victoria 3168, Australia,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Kelvin Hill
- Stroke Services and Research, Stroke Foundation, Bourke Street, Melbourne, Victoria 3000, Australia
| | - Adele K Gibbs
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Jot Ghuliani
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Victoria Street, Darlinghurst, New South Wales 2010, Australia,Australian Catholic University, Faculty of Health Sciences, Edward Street, North Sydney, New South Wales 2060, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Wright Street, Clayton, Victoria 3168, Australia,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Burgundy Street, Heidelberg, Victoria 3084, Australia
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11
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Cadilhac DA, Marion V, Andrew NE, Breen SJ, Grabsch B, Purvis T, Morrison JL, Lannin NA, Grimley RS, Middleton S, Kilkenny MF. A Stepped-Wedge Cluster-Randomized Trial to Improve Adherence to Evidence-Based Practices for Acute Stroke Management. Jt Comm J Qual Patient Saf 2022; 48:653-664. [PMID: 36307360 DOI: 10.1016/j.jcjq.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is limited evidence regarding the optimal design and composition of multifaceted quality improvement programs to improve acute stroke care. The researchers aimed to test the effectiveness of a co-designed multifaceted intervention (STELAR: Shared Team Efforts Leading to Adherence Results) directed at hospital clinicians for improving acute stroke care tailored to the local context using feedback of national registry indicator data. METHODS STELAR was a stepped-wedge cluster trial (partial randomization) using routinely collected Australian Stroke Clinical Registry data from Victorian hospitals segmented in two-month blocks. Each hospital (cluster) contributed control data from May 2017 and data for the intervention phase from July 2017 until September 2018. The intervention was multifaceted, delivered predominantly in two educational outreach workshops by experienced, external improvement facilitators, consisting of (1) feedback of registry data to identify practice gaps and (2) interprofessional education, barrier assessment, and documentation of an agreed action plan initiated by local clinical leaders appointed as change champions for prioritized clinical indicators. The researchers provided additional outreach support by e-mail/telephone for two months. Multilevel, multivariable regression models were used to assess change in a composite outcome of indicators selected for actions plans (primary outcome) and individual indicators (secondary outcome). Patient survival and disability 90-180 days after stroke were also compared. RESULTS Nine hospitals (clusters) participated, and 144 clinicians attended 18 intervention workshops. The control phase included 1,001 patients (median age 76.7 years; 47.4% female, 64.7% ischemic stroke), and the intervention phase 2,146 patients (median age 74.9 years; 44.2% female, 73.8% ischemic stroke). Compared to the control phase, the median score for the composite outcome for the intervention phase was 17% greater for the indicators included in the hospitals' action plans (range 3% to 30%, p = 0.016) and overall for the 10 indicators 6% greater (range 3% to 10%, p < 0.001). Compared to the control phase, patients in the intervention phase more often received stroke unit care (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.05-1.84), were discharged on antithrombotic medications (OR 1.87, 95% CI 1.50-2.33), and received a discharge care plan (OR 1.27, 95% CI 1.05-1.53). Patient outcomes were unchanged. CONCLUSION External quality improvement facilitation using workshops and remote support, aligned with routine monitoring via registries, can improve acute stroke care.
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12
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Cameron J, Lannin NA, Harris D, Andrew NE, Kilkenny MF, Purvis T, Thrift AG, Thayabaranathan T, Ellery F, Sookram G, Hackett M, Kneebone I, Drummond A, Cadilhac DA. A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Pilot Feasibility Stud 2022; 8:241. [PMCID: PMC9675218 DOI: 10.1186/s40814-022-01197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237
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Affiliation(s)
- Janette Cameron
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Natasha A. Lannin
- grid.1002.30000 0004 1936 7857Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia ,grid.267362.40000 0004 0432 5259Alfred Health, Melbourne, Australia
| | - Dawn Harris
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Nadine E. Andrew
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Monique F. Kilkenny
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Tara Purvis
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Amanda G. Thrift
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Tharshanah Thayabaranathan
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Fiona Ellery
- grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Garveeta Sookram
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Maree Hackett
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- grid.4563.40000 0004 1936 8868Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dominique A. Cadilhac
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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13
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Polhill E, Kilkenny MF, Cadilhac DA, Lannin NA, Dalli LL, Purvis T, Andrew NE, Thrift AG, Sundararajan V, Olaiya MT. Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2310328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Purvis T, Busingye D, Andrew NE, Kilkenny MF, Thrift AG, Li JC, Cameron J, Thijs V, Hackett ML, Kneebone I, Lannin NA, Cadilhac DA. Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self-management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE). Health Expect 2022; 25:2570-2581. [PMID: 35999689 PMCID: PMC9615081 DOI: 10.1111/hex.13584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/24/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Doreen Busingye
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Population Health, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,National Centre for Healthy Ageing, Monash University, Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan C Li
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Australian Centre for Heart Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Allied Health Directorate, Alfred Health, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
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15
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Purvis T, Middleton S, Alexandrov AW, Kilkenny MF, Coote S, Kuhle S, Cadilhac DA. Exploring barriers to stroke coordinator roles in Australia: A national survey. Collegian 2022. [DOI: 10.1016/j.colegn.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bravata DM, Purvis T, Kilkenny MF. Advances in Stroke: Quality Improvement. Stroke 2022; 53:1767-1771. [DOI: 10.1161/strokeaha.122.037450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dawn M. Bravata
- Health Services Research and Development Center for Health Information and Communication, Department of Veterans Affairs and Medicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.)
- Expanding Expertise Through E-health Network Development (EXTEND) Quality Enhancement Research Initiative (QUERI), Health Services Research and Development, Department of Veterans Affairs (VA), Indianapolis, IN (D.M.B.)
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.)
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, IN (D.M.B.)
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (T.P., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (T.P., M.F.K.)
| | - Monique F. Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (T.P., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (T.P., M.F.K.)
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17
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Barnden R, Cadilhac DA, Lannin NA, Kneebone I, Hersh D, Godecke E, Stolwyk R, Purvis T, Nicks R, Farquhar M, Gleeson S, Gore C, Herrmann K, Andrew NE. Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke. PEC Innov 2021; 1:100008. [PMCID: PMC10194112 DOI: 10.1016/j.pecinn.2021.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 06/17/2023]
Abstract
Objective Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. Methods A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. Results The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. Conclusion The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. Innovation We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.
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Affiliation(s)
- Rebecca Barnden
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Natasha A. Lannin
- School of Allied Health, Health Sciences Building 1, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
- Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ian Kneebone
- Graduate School of Health, Building 20, University of Technology Sydney, 100 Broadway, Ultimo, NSW 2007, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Rene Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Rd, Clayton, VIC 3800, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Rebecca Nicks
- Occupational Therapy Department, Eastern Health, 5 Arnold St, Box Hill, Melbourne, VIC 3128, Australia
| | | | - Stephanie Gleeson
- Occupational Therapy Department, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Carol Gore
- Subacute Care Services, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Kelsie Herrmann
- Lung Foundation Australia, 11 Finchley St, Milton, QLD 4064, Australia
| | - Nadine E. Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
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18
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Purvis T, Middleton S, Alexandrov AW, Kilkenny MF, Coote S, Kuhle S, Cadilhac DA. Understanding Coordinator Roles in Acute Stroke Care: A National Survey. J Stroke Cerebrovasc Dis 2021; 30:106111. [PMID: 34600180 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Coordinators contribute to stroke care quality. Evidence on the scope of practice of coordinator roles for stroke is lacking. We aimed to survey Australian stroke coordinators and describe their responsibilities and characteristics, and compare these based on perceived competency. MATERIALS AND METHODS Online survey of non-physician coordinators with a clinical leadership position for acute stroke in Australian hospitals. Participants were identified from the Stroke Foundation National Audit, and advertising via national associations/networks. Quantitative data were analysed descriptively; characteristics and responsibilities assessed by Benner's self-perceived competency (novice/advanced beginner/competent, proficient or expert). Inductive thematic analysis was used for open-ended responses. RESULTS Results from 105/141 coordinators (103 hospitals, 90% female, 90% registered nurses). Two-thirds developed the role/were self-taught, with 36% using the 'stroke coordinator' title. Perceived competency varied; 22% expert, 40% proficient, and 33% competent. A variety of important clinical tasks, along with leadership/management, education and research responsibilities were described. Most frequently reported clinical responsibility was discharge planning (77%), with patient and staff education (85% and 88%), and data collection (94%) common. Compared to those reporting lesser competency, 'experts' had greater involvement in outpatient clinics (50% vs 14%) and leadership/management responsibilities (e.g. local hospital committees 77% vs 46%). 'Knowledge of evidence' and 'empowering others' were important characteristics to 'expert' coordinators. CONCLUSIONS A contemporary understanding of important responsibilities and characteristics of acute stroke coordinators are provided. Perceived competency affected scope of practice. Structured education, training and role delineation is warranted to improve competency. Career development of stroke coordinators is urgently needed to support optimal role performance.
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Affiliation(s)
- Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australia; Australian Catholic University, Sydney, New South Wales, Australia
| | - Anne W Alexandrov
- College of Nursing & College of Medicine, and Department of Neurology, University of Tennessee Health Science Center, Tennessee, United States of America
| | - Monique F Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Skye Coote
- Melbourne Brain Centre and Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Kuhle
- Statewide Stroke Clinical Network, Queensland Health, Herston, Queensland, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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19
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Cahill LS, Lannin NA, Purvis T, Cadilhac DA, Mak-Yuen Y, O'Connor DA, Carey LM. What is "usual care" in the rehabilitation of upper limb sensory loss after stroke? Results from a national audit and knowledge translation study. Disabil Rehabil 2021; 44:6462-6470. [PMID: 34498991 DOI: 10.1080/09638288.2021.1964620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To characterise the assessments and treatments that comprise "usual care" for stroke patients with somatosensory loss, and whether usual care has changed over time. MATERIALS AND METHODS Comparison of cross-sectional, observational data from (1) Stroke Foundation National Audit of Acute (2007-2019) and Rehabilitation (2010-2018) Stroke Services and (2) the SENSe Implement multi-site knowledge translation study with occupational therapists and physiotherapists (n = 115). Descriptive statistics, random effects logistic regression, and content analysis were used. RESULTS Acute hospitals (n = 172) contributed 24 996 cases across audits from 2007 to 2019 (median patient age 76 years, 54% male). Rehabilitation services (n = 134) contributed organisational survey data from 2010 to 2014, with 7165 cases (median 76 years, 55% male) across 2016-2018 clinical audits (n = 127 services). Somatoensory assessment protocol use increased from 53% (2007) to 86% (2019) (odds ratio 11.4, 95% CI 5.0-25.6). Reported use of sensory-specific retraining remained stable over time (90-93%). Therapist practice reports for n = 86 patients with somatosensory loss revealed 16% did not receive somatosensory rehabilitation. The most common treatment approaches were sensory rehabilitation using everyday activities (69%), sensory re-education (68%), and compensatory strategies (64%). CONCLUSION Sensory assessment protocol use has increased over time while sensory-specific training has remained stable. Sensory rehabilitation in the context of everyday activities is a common treatment approach. Clinical trial registration number: ACTRN12615000933550IMPLICATIONS FOR REHABILITATIONOnly a small proportion of upper limb assessments conducted with stroke patients focus specifically on sensation; increased use of standardised upper limb assessments for sensory loss is needed.Stroke patients assessed as having upper limb sensory loss frequently do not receive treatment for their deficits.Therapists typically use everyday activities to treat upper limb sensory loss and may require upskilling in sensory-specific retraining to benefit patients.
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Affiliation(s)
- Liana S Cahill
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,School of Allied Health, Australian Catholic University, Melbourne, Australia
| | - Natasha A Lannin
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Allied Health (Occupational Therapy), Alfred Health, Melbourne, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Public Health and Health Services Evaluation, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Yvonne Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Thayabaranathan T, Andrew NE, Grimley R, Stroil-Salama E, Grabsch B, Hill K, Cadigan G, Purvis T, Middleton S, Kilkenny MF, Cadilhac DA. Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals. Healthcare (Basel) 2021; 9:healthcare9091095. [PMID: 34574869 PMCID: PMC8471416 DOI: 10.3390/healthcare9091095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI.
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Affiliation(s)
- Tharshanah Thayabaranathan
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Correspondence: ; Tel.: +61-3-8572-2646; Fax: +61-3-9902-4245
| | - Nadine E. Andrew
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
| | - Rohan Grimley
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
- Sunshine Coast Clinical School, Griffith University, Birtinya, QLD 4575, Australia
| | - Enna Stroil-Salama
- Metro South Research, Metro South Health, Brisbane, QLD 4102, Australia;
| | - Brenda Grabsch
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia;
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
| | - Tara Purvis
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australia and Australian Catholic University, Sydney, NSW 2010, Australia;
| | - Monique F. Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Dominique A. Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
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21
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Cadilhac DA, Cameron J, Kilkenny MF, Andrew NE, Harris D, Ellery F, Thrift AG, Purvis T, Kneebone I, Dewey H, Drummond A, Hackett M, Grimley R, Middleton S, Thijs V, Cloud G, Carey M, Butler E, Ma H, Churilov L, Hankey GJ, English C, Lannin NA. Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS). Int J Stroke 2021; 17:236-241. [PMID: 34037468 DOI: 10.1177/17474930211022678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. HYPOTHESIS Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. METHODS AND DESIGN Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. OUTCOMES Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. DISCUSSION We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
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Affiliation(s)
- Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Jan Cameron
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Dawn Harris
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Fiona Ellery
- Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Helen Dewey
- Eastern Health Clinical School, Monash University, Clayton, Australia.,Department of Neurosciences, Eastern Health, Box Hill, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Sunshine Coast Clinical School, Griffith University, Birtinya, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network, Sydney, Australia.,Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Vincent Thijs
- Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,Department of Neurology, Austin Health, Heidelberg, Australia
| | - Geoffrey Cloud
- Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Mariko Carey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Ernest Butler
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Coralie English
- School of Health Science and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia
| | - Natasha A Lannin
- Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Callisaya ML, Purvis T, Lawler K, Brodtmann A, Cadilhac DA, Kilkenny MF. Dementia is Associated With Poorer Quality of Care and Outcomes After Stroke: An Observational Study. J Gerontol A Biol Sci Med Sci 2020; 76:851-858. [DOI: 10.1093/gerona/glaa139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
To determine whether preexisting dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase.
Method
This was a retrospective analysis of pooled data from the Australian Stroke Foundation national audit conducted in 2015 and 2017. Dementia status was obtained from the medical records. Processes of care to assess quality included: stroke unit care, time-dependent therapy, nursing/allied health assessments, and preparation for discharge. Outcomes included in-hospital complications, independence on discharge, and destination. Logistic regression was used to examine associations between dementia status and processes of care. Multilevel random effects logistic regression, with level defined as hospital, was used to examine associations between dementia status and outcomes.
Results
There were 683/7,070 (9.7%) audited patients with dementia included. Patients with dementia were less likely to be treated in stroke units (58.3% vs 70.6%), receive thrombolysis if an ischemic stroke (5.8% vs 11.1%), have access within 48 hours to physiotherapy (56.4% vs 69.7%) or occupational therapy (46.8% vs 55.6%), see a dietitian if problems with nutrition (64.4% vs 75.9%), or have mood assessed (2.6% vs 12.3%). Patients with dementia were more likely to receive no rehabilitation (adjusted odds ratio 1.88, 95% confidence interval 1.25, 2.83) and be discharged to residential care (adjusted odds ratio 2.36, 95% confidence interval 1.50, 3.72).
Conclusion
People with dementia received poorer quality of care and had worse outcomes after stroke. Our findings raise questions regarding equity and the need for better understanding of why the quality of care differs after stroke for people with dementia.
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Affiliation(s)
- Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia
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Purvis T, Middleton S, Craig LE, Kilkenny MF, Dale S, Hill K, D'Este C, Cadilhac DA. Inclusion of a care bundle for fever, hyperglycaemia and swallow management in a National Audit for acute stroke: evidence of upscale and spread. Implement Sci 2019; 14:87. [PMID: 31477125 PMCID: PMC6721322 DOI: 10.1186/s13012-019-0934-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the Quality in Acute Stroke Care (QASC) trial undertaken in stroke units (SUs) located in New South Wales (NSW), Australia (2005-2010), facilitated implementation of a nurse-led care bundle to manage fever, hyperglycaemia and swallowing (FeSS protocols) reduced death and disability for patients with stroke. We aimed to determine subsequent adherence to the bundled FeSS processes (reflective of the protocols) between 2013 and 2017 in Australian hospitals, and examine whether changes in adherence to these processes varied based on previous participation in the QASC trial or subsequent statewide scale-up (QASCIP-Quality in Acute Stroke Care Implementation Project) and presence of an SU. METHODS Cross-sectional, observational study using self-reported organisational survey and retrospective clinical audit data from the National Acute Services Stroke Audit (2013, 2015, 2017). Mixed-effects logistic regression was performed with dependent variables: (1) composite outcome measure reflecting compliance with the FeSS protocols and (2) individual FeSS processes, including the year of audit as an independent variable, adjusted for correlation of outcomes within hospital. Separate models including interaction terms between the year of audit and previous participation in QASC/QASCIP and year of audit and SU were also generated. RESULTS Hospital participation included the following: 2013-124 hospitals, 3741 cases; 2015-112 hospitals, 4087 cases; and 2017-117 hospitals, 4192 cases. An 80% increase in the odds of receiving the composite outcome in 2017 compared to 2013 was found (2013, 30%; 2017, 41%; OR 1.8; 95% CI 1.6, 2.0; p < 0.001). The odds of FeSS adherence from 2013 to 2017 was greater for hospitals that had participated in QASC/QASCIP relative to those that had not (participated OR 2.1; 95% CI 1.7, 2.7; not participated OR 1.6; 95% CI 1.4, 1.8; p = 0.03). Similar uptake in adherence was evident in hospitals with and without an SU between 2013 and 2017. CONCLUSION The use of the FeSS protocols within Australia increased from 2013 to 2017 with the inclusion of these care processes in the National Audit. Greater uptake in hospitals previously involved in QASC/QASCIP was evident. Our implementation methods may be useful for other national initiatives for improving access to evidence-based practice.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne, Sydney, New South Wales, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
| | - Louise E Craig
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne, Sydney, New South Wales, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne, Sydney, New South Wales, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
| | - Kelvin Hill
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Stroke Foundation, Melbourne, Victoria, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Health and Medicine, Canberra, Australian Capital Territory, Australia.,School of Medicine and Public Health, University of Newcastle, Sydney, New South Wales, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
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Chapman C, Cadilhac DA, Morgan P, Kilkenny MF, Grimley R, Sundararajan V, Purvis T, Johnston T, Lannin NA, Andrew NE. Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry. Int J Stroke 2019; 15:390-398. [PMID: 30789321 DOI: 10.1177/1747493019833008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. METHODS Patient-level data from the Australian Stroke Clinical Registry (2010-13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. RESULTS Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). CONCLUSION Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
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Affiliation(s)
- Chantelle Chapman
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria Australia
| | - Prue Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria Australia
| | - Rohan Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Sunshine Coast Clinical School, University of Queensland, Birtinya, Queensland Australia
| | - Vijaya Sundararajan
- Department of Medicine, St. Vincent's Hospital, Melbourne University, Melbourne, Victoria Australia.,Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria Australia
| | - Tara Purvis
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia
| | - Trisha Johnston
- Health Statistics Branch, Queensland Department of Health, Brisbane, Queensland Australia
| | - Natasha A Lannin
- College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria Australia.,Occupational Therapy Department, Alfred Health, Prahran, Victoria Australia
| | - Nadine E Andrew
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria Australia
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Busingye D, Kilkenny MF, Purvis T, Kim J, Middleton S, Campbell BCV, Cadilhac DA. Is length of time in a stroke unit associated with better outcomes for patients with stroke in Australia? An observational study. BMJ Open 2018; 8:e022536. [PMID: 30420348 PMCID: PMC6252690 DOI: 10.1136/bmjopen-2018-022536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Spending at least 90% of hospital admission in a stroke unit (SU) is a recommended indicator of receiving high-quality stroke care. However, whether this makes a difference to patient outcomes is unknown. We aimed to investigate outcomes and factors associated with patients with acute stroke spending at least 90% of their admission in an SU, compared with those having less time in the SU. DESIGN Observational study using cross-sectional data. SETTING Data from hospitals which participated in the 2015 Stroke Foundation National Audit: Acute Services (Australia) and had an SU. This audit includes an organisational survey and retrospective medical record audit of approximately 40 admissions from each hospital. PARTICIPANTS Patients admitted to an SU during their acute admission were included. OUTCOME MEASURES Hospital-based patient outcomes included length of stay, independence on discharge, severe complications and discharge destination. Patient, organisational and process indicators were included in multilevel logistic modelling to determine factors associated with spending at least 90% of their admission in an SU. RESULTS Eighty-eight hospitals with an SU audited 2655 cases (median age 76 years, 55% male). Patients who spent at least 90% of their admission in an SU experienced: a length of stay that was 2 days shorter (coefficient -2.77, 95% CI -3.45 to -2.10), fewer severe complications (adjusted OR (aOR) 0.60, 95% CI 0.43 to 0.84) and were less often discharged to residential aged care (aOR 0.59, 95% CI 0.38 to 0.94) than those who had less time in the SU. Patients admitted to an SU within 3 hours of hospital arrival were three times more likely to spend at least 90% of their admission in an SU. CONCLUSION Spending at least 90% of time in an SU is a valid measure of stroke care quality as it results in improved patient outcomes. Direct admission to SUs is warranted.
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Affiliation(s)
- Doreen Busingye
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Monique F Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Joosup Kim
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Darlinghurst, New South Wales, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
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Abstract
BACKGROUND Chest infections occur in approximately one-third of patients following acute stroke, and are associated with poor outcomes. Limitations in previous reviews restricted the accuracy of results. OBJECTIVES To perform a systematic review to reliably identify modifiable risk factors for chest infections following acute stroke. METHODS Ovid Medline, CINAHL, Cochrane, EMBASE and AMED were searched from 1946 to April 2017 for observational studies where risk factors for chest infections in patients hospitalized with acute stroke were reported. Key words used to identify included chest infection or pneumonia. Included studies were evaluated based on methodological criteria and scientific quality. Results were collated and separate meta-analyses were performed for risk factors examined in three or more studies where quality and homogeneity criteria were met. RESULTS 3172 studies were identified, 15 were eligible for inclusion. Data collection methods included primary data collection, medical record audit and registry data. Chest infections were diagnosed 2-30 days following acute stroke in ten studies. Of the 39 risk factors identified, four were included in the meta-analysis. These were mechanical ventilation: 4 studies, OR: 3.83, 95%CI: 3.21, 4.57; diabetes: 4 studies, OR: 1.06, 95%CI: 1.04, 1.08; pre-existing respiratory conditions: 3 studies, OR: 1.48, 95%CI 1.21, 1.81 and atrial fibrillation: 3 studies, OR: 1.21, 95%CI: 1.17, 1.24. Common risk factors not eligible for meta-analysis were dysphagia and cardiac comorbidities. CONCLUSION Evidence has been comprehensively synthesized to provide reliable estimates of the association between important risk factors and chest infection. Monitoring patients meeting these criteria may promote early identification and treatment to improve long-term outcomes.
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Affiliation(s)
- Chantelle Chapman
- a Department of Physiotherapy , Monash University , Melbourne , Australia
| | - Prue Morgan
- a Department of Physiotherapy , Monash University , Melbourne , Australia
| | - Dominique A Cadilhac
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- c Florey Institute of Neurosciences and Mental Health , Heidelberg , Australia
| | - Tara Purvis
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Nadine E Andrew
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- d Peninsula Clinical School , Monash University , Clayton , Australia
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Purvis T, Kilkenny MF, Middleton S, Cadilhac DA. Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study. Int J Stroke 2017; 13:585-591. [PMID: 29134926 DOI: 10.1177/1747493017741382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1-2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
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Affiliation(s)
- Tara Purvis
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Monique F Kilkenny
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, Clayton, VIC, Australia
| | - Sandy Middleton
- 3 Nursing Research Institute, St Vincent's Health, Darlinghurst, NSW, Australia.,4 School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
| | - Dominique A Cadilhac
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.,2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, Clayton, VIC, Australia
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Purvis T, Moss K, Francis L, Borschmann K, Kilkenny MF, Denisenko S, Bladin CF, Cadilhac DA. Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia. Intern Med J 2017; 47:775-784. [DOI: 10.1111/imj.13458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
| | - Karen Moss
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Linda Francis
- School of Population and Global Health, Centre for Health Policy; The University of Melbourne; Melbourne Australia
| | - Karen Borschmann
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Monique F. Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
| | - Sonia Denisenko
- Department of Health and Human Services; Victorian Government; Melbourne Australia
| | - Christopher F. Bladin
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
- Eastern Health Clinical School; Monash University; Melbourne Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health; Monash University; Melbourne Australia
- Stroke Division; the Florey Institute of Neuroscience and Mental Health; Melbourne Australia
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Affiliation(s)
- Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 1/43-51 Kanooka Grove, Clayton, Victoria 3168, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Level 1/43-51 Kanooka Grove, Clayton, Victoria 3168, Australia
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Kilkenny MF, Dunstan L, Busingye D, Purvis T, Reyneke M, Orgill M, Cadilhac DA. Knowledge of risk factors for diabetes or cardiovascular disease (CVD) is poor among individuals with risk factors for CVD. PLoS One 2017; 12:e0172941. [PMID: 28245267 PMCID: PMC5330511 DOI: 10.1371/journal.pone.0172941] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background There is limited evidence on whether having pre-existing cardiovascular disease (CVD) or risk factors for CVD such as diabetes, ensures greater knowledge of risk factors important for motivating preventative behaviours. Our objective was to compare knowledge among the Australian public participating in a health check program and their risk status. Methods Data from the Stroke Foundation ‘Know your numbers’ program were used. Staff in community pharmacies provided opportunistic health checks (measurement of blood pressure and diabetes risk assessment) among their customers. Participants were categorised: 1) CVD ± risk of CVD: history of stroke, heart disease or kidney disease, and may have risk factors; 2) risk of CVD only: reported having high blood pressure, high cholesterol, diabetes or atrial fibrillation; and 3) CVD risk free (no CVD or risk of CVD). Multivariable logistic regression analyses were performed including adjustment for age and sex. Findings Among 4,647 participants, 12% had CVD (55% male, 85% aged 55+ years), 47% were at risk of CVD (40% male, 72% 55+ years) and 41% were CVD risk free (33% male, 27% 55+ years). Participants with CVD (OR: 0.66; 95% CI: 0.55, 0.80) or risk factors for CVD (OR: 0.65; 95% CI: 0.57, 0.73) had poorer knowledge of the risk factors for diabetes/CVD compared to those who were CVD risk free. After adjustment, only participants with risk factors for CVD (OR: 0.80; 95% CI: 0.69, 0.93) had poorer knowledge. Older participants (55+ years) and men had poorer knowledge of diabetes/CVD risk factors and complications of diabetes. Conclusions Participants with poorer knowledge of risk factors were older, more often male or were at risk of developing CVD compared with those who were CVD risk free. Health education in these high risk groups should be a priority, as diabetes and CVD are increasing in prevalence throughout the world.
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Affiliation(s)
- Monique F. Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
- Stroke Division: Public Health, the Florey Institute of Neurosciences and Mental Health, Heidelberg, Victoria, Australia
- * E-mail:
| | | | - Doreen Busingye
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Tara Purvis
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
- Stroke Division: Public Health, the Florey Institute of Neurosciences and Mental Health, Heidelberg, Victoria, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Mary Orgill
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
- Stroke Division: Public Health, the Florey Institute of Neurosciences and Mental Health, Heidelberg, Victoria, Australia
- The University of Melbourne, Victoria, Australia
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Purvis T, Hill K, Kilkenny M, Andrew N, Cadilhac D. Improved in-hospital outcomes and care for patients in stroke research: An observational study. Neurology 2016; 87:206-13. [PMID: 27306625 DOI: 10.1212/wnl.0000000000002834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe stroke research activity in Australian acute public hospitals and determine if participation in research provides better quality of care and outcomes for patients with stroke. METHODS This was an observational study using data from hospitals that participated in the National Stroke Foundation (Australia) acute services audit program in 2009, 2011, and 2013. This included self-reported organizational features and a retrospective clinical audit of up to 40 medical records of patients with stroke from each hospital. Multilevel random effects logistic regression with level defined as hospital and adjustments for hospital, demographic, clinical, and stroke severity factors were undertaken. RESULTS A total of 240 hospitals submitted organizational data. Hospitals with a stroke unit (70% vs 7%, p < 0.001) and >200 stroke admissions per year (80% vs 17%, p < 0.001) reported greater involvement in research studies. Of 9,537 patients audited at 129 hospitals, 469 (5%) consented to participate in research. Patients who participated in research compared to nonparticipants were likely to be younger (median age 73 years; 25th percentile [Q1]: 63, 75th percentile [Q3]: 80, vs median age 76 years Q1: 64, Q3: 83; p < 0.001) and receive important clinical practices such as a swallow screen/assessment prior to oral intake (62% vs 56%; p < 0.01). An independent association with reduced in-hospital mortality (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.76) was evident if participating in research regardless of access to stroke unit care. CONCLUSIONS Patients who participate in stroke research receive better in-hospital care and are more likely to survive compared to nonresearch participants. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with stroke who participate in research receive better quality of care and have reduced in-hospital mortality.
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Affiliation(s)
- Tara Purvis
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia.
| | - Kelvin Hill
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Monique Kilkenny
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Nadine Andrew
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Dominique Cadilhac
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
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Shahid M, Albergo N, Purvis T, Heron K, Gaston L, Carter S, Grimer R, Jeys L. Management of sarcomas possibly involving the knee joint when to perform extra-articular resection of the knee joint and is it safe? Eur J Surg Oncol 2016; 43:175-180. [PMID: 27266818 DOI: 10.1016/j.ejso.2016.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/07/2016] [Accepted: 05/13/2016] [Indexed: 12/18/2022] Open
Abstract
We reviewed the oncological and functional outcomes of patients treated for a primary sarcoma possibly involving the knee joint and present an algorithm to guide treatment. The records of 76 patients who had a primary bone or soft tissue sarcoma possibly invading the knee between 1996 and 2012 were identified. Mean age and follow-up was 32 years (9-74) and 64 months (12-195), respectively. Patients were grouped according to the resection (Intra-articular [IAR] vs. Extra-articular [EAR] vs. Amputation/rotationplasty) for survival and functional outcomes. Overall 5 and 10 year survival was 61% and 53%, respectively. No differences in survival were found between the 3 groups (p = 0.55). Sixteen patients developed local recurrence with no difference between the groups. Mean MSTS score was 24.5 (12-30). Mean flexion at final follow-up was 106° (70-130°). We conclude that EAR of the knee allows for good oncologic and functional outcomes but with an increased risk of complications compared to IAR. Intra-operative assessment of joint involvement can be done in patients where joint infiltration by the tumour is not clear to avoid an unnecessary EAR. For chondrosarcoma patients with joint involvement, an EAR should be carefully considered because they present a significantly higher local recurrence risk.
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Affiliation(s)
- M Shahid
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - N Albergo
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - T Purvis
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - K Heron
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L Gaston
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S Carter
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Grimer
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - L Jeys
- Bone Tumour Unit, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Brock K, Birnbaum M, Graven C, Purvis T, Cadilhac D. Development and implementation of the chronic stroke review tool and intervention guide (Rev-TIG). Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Caregivers play a crucial role in meeting the needs of survivors of stroke. Yet, little is known about how they are impacted by their caregiving role. OBJECTIVES To describe the relationship between survivor long-term unmet needs (>12 months) and caregiver impacts, and identify characteristics that are associated with reported moderate to severe impacts on caregivers. METHOD This was a cross-sectional survey using data from the Australian Stroke Survivor and Carer Needs Survey. Community dwelling adults 12+ months poststroke and their caregivers participated. Caregivers and survivors were asked about the extent to which the domains of work, leisure and family, and friend and spousal relationships had been impacted using a Likert scale of responses. The extent to which survivor needs were being met was measured over the domains of health, everyday living, work, leisure, and finances, and the total number of unmet needs was calculated. The association between survivor unmet needs and caregiver impacts was assessed using multivariable logistic regression adjusted for caregiver and survivor characteristics. RESULTS Of the 738 completed survivor surveys, 369 contained matched caregiver data (survivors: median age, 71 years; 67% male) (caregivers: median age, 64 years; 26% male). For caregivers, the domains of work, leisure, and friendships were most impacted. The odds of a caregiver experiencing moderate to extreme impacts increased with the number of reported survivor unmet needs. This was greatest for spousal (aOR [adjusted odds ratio]: 1.14; 95% CI [confidence interval]: 1.07, 1.21; P<0.001) and friend relationships (aOR: 1.14; 95% CI: 1.07, 1.21; P<0.001). Caring for a survivor who needed daily living assistance was associated with moderate to extreme caregiver impacts across all domains. CONCLUSION Caregivers of survivors of stroke experience large negative impacts, the extent to which is associated with survivors unmet needs. Targeted, long-term solutions are needed to support survivors and caregivers living in the community.
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Affiliation(s)
- Nadine E Andrew
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Correspondence: Nadine E Andrew, Translational Public Health and Evaluation Division, Stroke and Aging Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia, Tel +61 3 9594 7509, Fax +61 3 9902 4245, Email
| | - Monique F Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | | | - Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Walton G, Purvis T, Chadwick C, Stockley R, Sapey E. S46 Phagocytosis By Blood Neutrophils Is Not Attenuated In Patients With Chronic Obstructive Pulmonary Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kilkenny MF, Johnson R, Andrew NE, Purvis T, Hicks A, Colagiuri S, Cadilhac DA. Comparison of two methods for assessing diabetes risk in a pharmacy setting in Australia. BMC Public Health 2014; 14:1227. [PMID: 25427845 PMCID: PMC4289299 DOI: 10.1186/1471-2458-14-1227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background Since 2007, the Australian Know your numbers (KYN) program has been used in community settings to raise awareness about blood pressure and stroke. In 2011, the program was modified to include assessment for type 2 diabetes risk. However, it is unclear which approach for assessing diabetes risk in pharmacies is best. We compared two methods: random (non-fasting) blood glucose testing (RBGT); and the Australian type 2 diabetes risk assessment tool (AUSDRISK); according to 1) identification of ‘high risk’ participants including head-to-head sensitivity and specificity; 2) number of referrals to doctors; and 3) feasibility of implementation. Methods 117 Queensland pharmacies voluntarily participated and were randomly allocated to RBGT and AUSDRISK or AUSDRISK only. Although discouraged, pharmacies were able to change allocated group prior to commencement. AUSDRISK is a validated self-administered questionnaire used to calculate a score that determines the 5-year risk of developing type 2 diabetes. AUSDRISK (score 12+) or RBGT (≥5.6 mmol/I) indicates a high potential risk of diabetes. Median linear regression was used to compare the two measures. Staff from 68 pharmacies also participated in a semi-structured interview during a site visit to provide feedback. Results Data were submitted for 5,483 KYN participants (60% female, 66% aged >55 years, 10% history of diabetes). Approximately half of the participants without existing diabetes were identified as ‘high risk’ based on either RBGT or AUSDRISK score. Among participants who undertook both measures, 32% recorded a high RBGT and high AUSDRISK. There was a significant association between RBGT and AUSDRISK scores. For every one point increase in AUSDRISK score there was a half point increase in RBGT levels (coefficient 0.55, 95% CI: 0.28, 0.83). Pharmacy staff reported that AUSDRISK was a simple, low cost and efficient method of assessing diabetes risk compared with RBGT, e.g. since management of sharps is not an issue. Conclusions In a large, community-based sample of Australians about half of the participants without diabetes were at ‘high risk ‘of developing diabetes based on either AUSDRISK or RBGT results. AUSDRISK was considered to be an acceptable method for assessing the risk of diabetes using opportunistic health checks in community pharmacies. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1227) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research School of Clinical Sciences at Monash Health, Monash University, Level 1/43-51 Kanooka Grove, Clayton, 3168 Melbourne, VIC, Australia.
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Purvis T, Moss K, Denisenko S, Bladin C, Cadilhac DA. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators. J Multidiscip Healthc 2014; 7:389-400. [PMID: 25246799 PMCID: PMC4168868 DOI: 10.2147/jmdh.s67348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A stroke care strategy was developed in 2007 to improve stroke services in Victoria, Australia. Eight stroke network facilitators (SNFs) were appointed in selected hospitals to enable the establishment of stroke units, develop thrombolysis services, and implement protocols. We aimed to explain the main issues being faced by clinicians in providing evidence-based stroke care, and to determine if the appointment of an SNF was perceived as an acceptable strategy to improve stroke care. Face-to-face semistructured interviews were used in a qualitative research design. Interview transcripts were verified by respondents prior to coding. Two researchers conducted thematic analysis of major themes and subthemes. Overall, 84 hospital staff participated in 33 interviews during 2008. The common factors found to impact on stroke care included staff and equipment availability, location of care, inconsistent use of clinical pathways, and professional beliefs. Other barriers included limited access to specialist clinicians and workload demands. The establishment of dedicated stroke units was considered essential to improve the quality of care. The SNF role was valued for identifying gaps in care and providing capacity to change clinical processes. This is the first large, qualitative multicenter study to describe issues associated with delivering high-quality stroke care and the potential benefits of SNFs to facilitate these improvements.
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Affiliation(s)
- Tara Purvis
- Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Karen Moss
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia
| | - Sonia Denisenko
- Commission for Hospital Improvement, Department of Health Victoria, VIC, Australia
| | - Chris Bladin
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Dominique A Cadilhac
- Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Monash Medical Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia ; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia ; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
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Andrew NE, Kilkenny M, Naylor R, Purvis T, Lalor E, Moloczij N, Cadilhac DA. Understanding long-term unmet needs in Australian survivors of stroke. Int J Stroke 2014; 9 Suppl A100:106-12. [PMID: 25042019 DOI: 10.1111/ijs.12325] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke. METHOD Multifaceted strategies were used to obtain a national sample. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used. RESULTS Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met (P < 0·001). Factors associated with needs not being fully met were as follows: (1) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain); (2) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain); and (3) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain). CONCLUSION The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.
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Affiliation(s)
- Nadine E Andrew
- Translational Public Health and Evaluation Unit, Stroke & Ageing Research, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
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Sadhra CS, Purvis T, Walton GM, Stockley JA, Stockley RA, Sapey E. S114 Simvastatin improves neutrophil migratory targeting in COPD: in vitrostudies supporting Statin use as a potential adjuvant therapy. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cadilhac DA, Purvis T, Kilkenny MF, Longworth M, Mohr K, Pollack M, Levi CR. Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals? Stroke 2013; 44:2848-53. [PMID: 23950561 DOI: 10.1161/strokeaha.113.001258] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. METHODS A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients ≥12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. RESULTS SAMPLE pre-RSP n=750; mean age 74 (SD, 13) years; women 50% and post-RSP n=730; mean age 74 (SD, 13) years; women 46%. Many improvements in stroke care were found after RSP: access to stroke units (pre 0%; post 58%, P<0.001); use of aspirin within 24 hours of ischemic stroke (pre 59%; post 71%, P<0.001); use of care plans (pre 15%; post 63%, P<0.001); and allied health assessments within 48 hours (pre 65%; post 82% P<0.001). After implementation of the RSP, patients directly admitted to an RSP hospital were 89% more likely to be discharged home (adjusted odds ratio, 1.89; 95% confidence interval, 1.34-2.66). CONCLUSIONS Investment in clinical coordinators who implemented organizational change, together with increased clinician resources, effectively improved stroke care in rural hospitals, resulting in more patients being discharged home.
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Affiliation(s)
- Dominique A Cadilhac
- From the Translational Public Health Unit, Stroke and Ageing Research Centre, Department of Medicine, Southern Clinical School, Monash University, Clayton, Australia (D.A.C., T.P., M.K.); Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Australia (D.A.C., T.P., M.K.); Stroke Services New South Wales, New South Wales Agency for Clinical Innovation, New South Wales, Australia (M.L.); Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia (K.M.); Hunter Stroke Service, Hunter New England Area Health, Rankin Park Centre, New South Wales, Australia (M.P.); Centre for Brain and Mental Health Research, University of Newcastle and Hunter Medical Research Institute, New Lambton, New South Wales, Australia (C.L.); and John Hunter Hospital, Newcastle, New South Wales, Australia (C.L.)
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Zhao H, Collier JM, Quah DM, Purvis T, Bernhardt J. The modified Rankin Scale in acute stroke has good inter-rater-reliability but questionable validity. Cerebrovasc Dis 2009; 29:188-93. [PMID: 20029188 DOI: 10.1159/000267278] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 09/03/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The modified Rankin Scale (mRS), designed as a measure of disability in the community, has increasingly been administered in the acute stroke setting but has been poorly studied within the hospital environment. We prospectively studied the interrater reliability of the mRS in acutely hospitalised stroke patients and examined the effect of prior experience with the scale and use of a decision tool on the interrater agreement of trained raters. METHODS Patients <4 days after stroke were recruited. Individuals from 3 trained rater groups (experienced, inexperienced and inexperienced with decision tool) independently scored each patient within 6 h of each other. Agreement was measured with the intraclass correlation (ICC) and the weighted kappa statistic (kappa(w)), with systematic bias evaluated using the bias index. RESULTS Twelve raters scored 56 patients with overall agreement of ICC = 0.675. Agreement of kappa(w) = 0.686 was found between experienced and inexperienced raters but a modest systematic bias was present. Experience in rating patients appeared to play some role in affecting agreement but the decision tool did not improve the performance of inexperienced raters. CONCLUSIONS Trained raters were found to have good interrater agreement overall when the mRS was scored in acute stroke patients but obvious problems with the interpretation and relevancy of the scale in this setting raise concerns about validity. The use of the mRS to rate disability in the acute hospital environment should be questioned.
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Affiliation(s)
- Henry Zhao
- School of Medicine, University of Melbourne, Victoria, Australia
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Purvis T, Cadilhac D, Donnan G, Bernhardt J. Systematic Review of Process Indicators: Including Early Rehabilitation Interventions Used to Measure Quality of Acute Stroke Care. Int J Stroke 2009; 4:72-80. [DOI: 10.1111/j.1747-4949.2009.00256.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Stroke is a leading cause of disease burden. The quality of care provided in hospitals can affect outcome. Therefore, examining adherence to clinically important processes of care can help improve care delivery and patient outcomes. However, knowing which process indicators to measure is essential. Aim Systematically review process indicators used to evaluate acute stroke services, including early rehabilitation interventions, and assess whether published indicators conform to clinical guidelines. Methods Publications (1985-2006) were identified by systematically searching databases (e.g. Medline and Cochrane Library), and the internet using free text terms: ‘stroke unit’, ‘process’, ‘quality’, ‘mobilisation’, ‘acute’, and ‘early rehabilitation’. Publications describing process indicators relating to the first 2 weeks of in-patient stroke care were included. Process indicators were categorised according to six clinical process domains covering the acute stroke admission. Commonly cited indicators (≥6 publications) were then mapped to the 2003 Australian clinical guidelines. Results Sixty potential studies were found from title and abstract. Following full text review, 32 publications were retained. Of the 161 process indicators identified, 43 were commonly cited. Seventy-nine per cent of commonly cited indicators were found in the guidelines. The level of evidence underpinning each indicator ranged from low ‘expert opinion’ (59%), to high, ‘level 1’ (12%) evidence. Indicators related to rehabilitation were rare. Conclusion Many acute stroke process indicators have been published. However, a quarter did not align with current clinical guidelines. Developing an ‘ideal set’ of process indicators to reflect the evidence base seems sensible and should include rehabilitation interventions.
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Affiliation(s)
- T. Purvis
- Physiotheraphy Department, Austin Health, Melbourne, Australia
| | - D. Cadilhac
- Department of Medicine, University of Melbourne, Melbourne, Australia
- National Stroke Research Institute (part of Florey Neuroscience Institutes), Melbourne, Australia
- Public Health Research Cluster, Deakin University, Melbourne, Australia
| | - G. Donnan
- National Stroke Research Institute (part of Florey Neuroscience Institutes), Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - J. Bernhardt
- Department of Medicine, University of Melbourne, Melbourne, Australia
- National Stroke Research Institute (part of Florey Neuroscience Institutes), Melbourne, Australia
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