Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry

Stroke. 2017 Apr;48(4):1026-1032. doi: 10.1161/STROKEAHA.116.015714. Epub 2017 Mar 3.

Abstract

Background and purpose: Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke.

Methods: Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received.

Results: There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%).

Conclusions: Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.

Keywords: hospitals; quality of health care; quality of life; stroke; survival.

MeSH terms

  • Aftercare
  • Aged
  • Aged, 80 and over
  • Australia / epidemiology
  • Critical Care / standards*
  • Critical Care / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / standards*
  • Outcome Assessment, Health Care / statistics & numerical data
  • Patient Discharge / standards*
  • Patient Discharge / statistics & numerical data
  • Practice Guidelines as Topic / standards*
  • Quality Indicators, Health Care / standards*
  • Quality Indicators, Health Care / statistics & numerical data
  • Quality of Life*
  • Registries / statistics & numerical data*
  • Stroke / epidemiology
  • Stroke / mortality*
  • Stroke / therapy*