Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care
| Autor: | Craig S. Anderson, Christopher Levi, Amanda G. Thrift, John Wakefield, Kelvin Hill, Brenda Grabsch, Sandy Middleton, Steven G Faux, Rohan Grimley, Nadine E. Andrew, Dominique A Cadilhac, Greg Cadigan, Geoffrey A. Donnan, Monique F Kilkenny, Natasha A. Lannin |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Quality management Original Contributions Clinical Sciences Psychological intervention Audit historically controlled study 03 medical and health sciences 0302 clinical medicine quality of health care Medicine Prospective Studies 030212 general & internal medicine health services humans Prospective cohort study reimbursement incentive Stroke Reimbursement Aged Advanced and Specialized Nursing business.industry Middle Aged medicine.disease Quality Improvement reimbursement stroke incentive 3. Good health Clinical trial Historically Controlled Study Emergency medicine ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female Queensland Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Stroke |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.118.023075 |
| Popis: | Supplemental Digital Content is available in the text. Background and Purpose— Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods— A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results— There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%–24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%–20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%–17%). The national score (4 indicators) improved by 17% (95% CI, 13%–20%) versus 0% change in other Australian hospitals (95% CI, −0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals (P |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|