Are we providing patients with the best achievable care? Update from the australian stroke clinical registry

Abstract

Background: In Australia, understanding of the impact of evidencebased care on patient outcomes was limited prior to establishment of the Australian Stroke Clinical Registry (AuSCR) in 2009. Aims: To report on the cumulative knowledge generated from the first eight years of operating AuSCR within Australia. In particular, new data from 2015 are presented. Methods: AuSCR data were analysed for stroke and transient ischaemic attack (TIA) admissions (2009-2015) using multivariable models for outcome comparisons, including survival and health-related quality of life (HRQoL) within 180 days. Updated benchmarks for national clinical indicators (stroke unit [SU] care; thrombolysis for ischaemic stroke; discharge on antihypertensives; discharge care plan) were generated from the best performing hospitals. Results: Since 2009, 46,000+ episodes of care and 20,500+ follow-up surveys have been completed. For patients admitted with TIA, care in a SU care was associated with improved survival (N=2220, hazard ratio 0.57). Patients with stroke (N=,585) cared for in an acute SU had reduced likelihood of death (hazard ratio 0.49) and better HRQoL (coefficient 21.34). These benefits were augmented with greater adherence to other clinical indicators. Achievable benchmarks were generated from 2015 data (9,473 episodes): SU care 96%, thrombolysis 19%; antihypertensives at discharge 87%; discharge care plan 92%. We also found that comparisons of hospital stroke mortality rates were more reliable when stroke severity was used in statistical analyses. Discussion: Variation in adherence to national clinical indicators impacts on long-term patient outcomes. Hospitals need to be supported to ensure provision of best-practice care and reach achievable benchmarks.L617955049 <br />