Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR)
Objective To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia.Design Observational study using data from a multicentre national registry.Setting Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which parti...
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e040418.full |
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| author | Joosup Kim Dominique A Cadilhac Richard White Natasha A Lannin Fiona Ryan Karen Ford Mitchell Dwyer Karen Francis Gregory M Peterson Seana Gall Hoang Phan Helen Castley Lillian Wong Lauren Arthurson |
| author_facet | Joosup Kim Dominique A Cadilhac Richard White Natasha A Lannin Fiona Ryan Karen Ford Mitchell Dwyer Karen Francis Gregory M Peterson Seana Gall Hoang Phan Helen Castley Lillian Wong Lauren Arthurson |
| author_sort | Joosup Kim |
| collection | DOAJ |
| description | Objective To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia.Design Observational study using data from a multicentre national registry.Setting Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010–2015.Participants Patients were divided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas.Primary and secondary outcome measures Regional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90–180 days.Results Compared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p<0.001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p<0.001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p<0.001). No significant differences were found in terms of survival or overall self-reported quality of life.Conclusions Rural access to recommended components of acute stroke care was comparatively poorer; however, this did not appear to impact health outcomes at approximately 6 months. |
| format | Article |
| id | doaj-art-bc334a3aa0224d97b8aa9a28f0354c64 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-bc334a3aa0224d97b8aa9a28f0354c642024-11-21T19:55:09ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-040418Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR)Joosup Kim0Dominique A Cadilhac1Richard White2Natasha A Lannin3Fiona Ryan4Karen Ford5Mitchell Dwyer6Karen Francis7Gregory M Peterson8Seana Gall9Hoang Phan10Helen Castley11Lillian Wong12Lauren Arthurson13Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, AustraliaDepartment of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, AustraliaInfectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKOccupational Therapy Department, Alfred Hospital, Melbourne, Victoria, AustraliaOrange and Bathurst Health Services, NSW Health, North Sydney, New South Wales, AustraliaSchool of Nursing, University of Tasmania, Hobart, Tasmania, AustraliaTasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, AustraliaSchool of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia18 School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, AustraliaMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, AustraliaMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, AustraliaNeurology Department, Royal Hobart Hospital, Hobart, Tasmania, AustraliaPrincess Alexandra Hospital, QLD Health, Woolloongabba, Queensland, AustraliaInpatient Rehabilitation, Echuca Regional Health, Echuca, Victoria, AustraliaObjective To compare the processes and outcomes of care in patients who had a stroke treated in urban versus rural hospitals in Australia.Design Observational study using data from a multicentre national registry.Setting Data from 50 acute care hospitals in Australia (25 urban, 25 rural) which participated in the Australian Stroke Clinical Registry during the period 2010–2015.Participants Patients were divided into two groups (urban, rural) according to the Australian Standard Geographical Classification Remoteness Area classification. Data pertaining to 28 115 patients who had a stroke were analysed, of whom 8159 (29%) were admitted to hospitals located within rural areas.Primary and secondary outcome measures Regional differences in processes of care (admission to a stroke unit, thrombolysis for ischaemic stroke, discharge on antihypertensive medication and provision of a care plan), and survival analyses up to 180 days and health-related quality of life at 90–180 days.Results Compared with those admitted to urban hospitals, patients in rural hospitals less often received thrombolysis (urban 12.7% vs rural 7.5%, p<0.001) or received treatment in stroke units (urban 82.2% vs rural 76.5%, p<0.001), and fewer were discharged with a care plan (urban 61.3% vs rural 44.7%, p<0.001). No significant differences were found in terms of survival or overall self-reported quality of life.Conclusions Rural access to recommended components of acute stroke care was comparatively poorer; however, this did not appear to impact health outcomes at approximately 6 months.https://bmjopen.bmj.com/content/11/4/e040418.full |
| spellingShingle | Joosup Kim Dominique A Cadilhac Richard White Natasha A Lannin Fiona Ryan Karen Ford Mitchell Dwyer Karen Francis Gregory M Peterson Seana Gall Hoang Phan Helen Castley Lillian Wong Lauren Arthurson Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) BMJ Open |
| title | Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) |
| title_full | Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) |
| title_fullStr | Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) |
| title_full_unstemmed | Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) |
| title_short | Regional differences in the care and outcomes of acute stroke patients in Australia: an observational study using evidence from the Australian Stroke Clinical Registry (AuSCR) |
| title_sort | regional differences in the care and outcomes of acute stroke patients in australia an observational study using evidence from the australian stroke clinical registry auscr |
| url | https://bmjopen.bmj.com/content/11/4/e040418.full |
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