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dc.contributor.authorCadilhac, DA
dc.contributor.authorGrimley, R
dc.contributor.authorKilkenny, MF
dc.contributor.authorAndrew, NE
dc.contributor.authorLannin, NA
dc.contributor.authorHill, K
dc.contributor.authorGrabsch, B
dc.contributor.authorLevi, CR
dc.contributor.authorThrift, AG
dc.contributor.authorFaux, SG
dc.contributor.authorWakefield, J
dc.contributor.authorCadigan, G
dc.contributor.authorDonnan, GA
dc.contributor.authorMiddleton, S
dc.contributor.authorAnderson, CS
dc.date.accessioned2020-06-15T00:22:17Z
dc.date.available2020-06-15T00:22:17Z
dc.date.issued2019
dc.identifier.issn0039-2499
dc.identifier.doi10.1161/STROKEAHA.118.023075
dc.identifier.urihttp://hdl.handle.net/10072/394612
dc.description.abstractBackground 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<0.001). Conclusions: The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.relation.ispartofpagefrom1525
dc.relation.ispartofpageto1530
dc.relation.ispartofissue6
dc.relation.ispartofjournalStroke
dc.relation.ispartofvolume50
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchNeurosciences
dc.subject.fieldofresearchcode3201
dc.subject.fieldofresearchcode3202
dc.subject.fieldofresearchcode3209
dc.subject.keywordshealth services
dc.subject.keywordshistorically controlled study
dc.subject.keywordshumans
dc.subject.keywordsquality of health care
dc.subject.keywordsreimbursement, incentive
dc.titleMulticenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationCadilhac, DA; Grimley, R; Kilkenny, MF; Andrew, NE; Lannin, NA; Hill, K; Grabsch, B; Levi, CR; Thrift, AG; Faux, SG; Wakefield, J; Cadigan, G; Donnan, GA; Middleton, S; Anderson, CS, Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care, Stroke, 2019, 50 (6), pp. 1525-1530
dcterms.licensehttp://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated2020-06-15T00:19:27Z
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2019 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited and is not used for commercial purposes.
gro.hasfulltextFull Text
gro.griffith.authorGrimley, Rohan


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