Public Health Research   Health Care Delivery Stroke Unit Audits

Several audit tools that build on pre-existing work of the Division have been developed to evaluate the quality of care in hospitals that treat stroke. These audit tools focus on the stucture, process and outcomes of care. These tools have been used as part of various time series audits to explain changes in clinical practice through time. Up to 24 hospitals in New South Wales, as part of the Greater Metropolitan Clinical Taskforce (GMCT) initiative have been collecting data. There is also one Melbourne hospital which has applied repeated surveys to infomr clinical practice and assess care quality.

Determining Differences in Stroke Unit Care: Melbourne versus Trondheim

This project aims to examine in what way processes of care differ between stroke units at Austin Health and St Olavs Hospital in Trondheim, Norway (Gold Standard Care). The design involves a mixed methods approach. Quantitative data from retrospective medical record audits of 50 consecutive stroke patients per hospital will be used. This audit tool includes newly developed early rehabilitation process of care indicators. In addtion, qualitative information will be obtained from hospital staff working in these units. Three to five semi-structured interviews will be conducted to gain perceptions on how the service is organised and the way in which it operates. In turn, qualitative and audit data from both countries will be analysed to determine how stroke care delivery differs between the sites. Our objective is to identify factors that might be associated with better stroke outcomes, particularly in relation to early rehabilitation practices. This infomration may be used to help improve care in existing stroke units, or inform the development of new stroke units.

National Stroke Services Audit of Acute Public Hospitals

In conjunction with the National Stroke Foundation, we conduct regular surveys of hospitals to describe the services available for stroke and related clinical practice. For example, the number of geographically localised stroke units in Australia and the uptake of clinical practice guidelines. Prior surveys were undertaken in 1999 and 2004. In 2004, there were 50 stroke units in Australian acute public hospitals.

 

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Public Health

Evaluation of the National Stroke Foundation Self-Management Pilot Program

The self-management program is an eight session, community-based program for stroke survivors and carers to promote self-efficacy. The pilot program was conducted in South Australia. We assisted in evaluating this pilot program for the National Stroke Foundation using sequential participant survey techniques.

Sleep Disordered Breathing in Chronic Stroke

Ongoing analysis of the SCOPES II cohort data and sleep disordered breathing questionnaires obtained from the NEMESIS sample are being used to validate the use of a questionnaire based screening tool for sleep disordered breathing in stroke.

 

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Economic Evaluation

Working in collaboration with the Epidemiology Division and The University of Melbourne- Health Economics Group (School of Population Health), the following projects have been undertaken or are entrain:

Economic evaluation of blood pressure lowering interventions for stroke

The project is being undertaking as a PhD by Dominique Cadilhac and involves the updating of a stroke specific economic model (Model of Resource Utilisation Cost and Outcomes for Stroke [MORUCOS]) and uses contemporary priority setting methods with stakeholder involvement. Up to eight interventions are being systematically evaluated that span the care pathway (primary prevention to long term chronic disease management).

As part of this work, an economic appraisal of the potential health benefits and cost implications of a national public health program for stroke was undertaken. This has been used by the National Stroke Foundation to assist in developing an investment argument to potential funders/sponsors for their 10-year public health campaign (strokesafe). Given population predictions for 2015, we found that about 27 000 strokes (38%) could be prevented. In particular, blood pressure lowering interventions were the most influential for producing health gains and cost offsets. This provided the rationale for focusing further detailed economic evaluation on blood pressure lowering interventions.