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Kim J, Sookram G, Godecke E, Brogan E, Armstrong E, Ellery F, Rai T, Rose ML, Ciccone N, Middleton S, Holland A, Hankey GJ, Bernhardt J, Cadilhac DA. Economic evaluation of the Very Early Rehabilitation in SpEech (VERSE) intervention. Top Stroke Rehabil 2024; 31:157-166. [PMID: 37415422 DOI: 10.1080/10749357.2023.2229039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided. METHODS A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017-18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ). RESULTS Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care. CONCLUSION There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.
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Affiliation(s)
- J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - G Sookram
- Health Economics Unit, Australian Institute of Health and Welfare, Canberra, Australia
| | - E Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - E Brogan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Speech Pathology Department, Sir Charles Gairdner Hospital, Perth, Australia
| | - E Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - F Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - T Rai
- School of Mathematical and Physical Sciences, University of Technology NSW, Broadway, Australia
| | - M L Rose
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - N Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - S Middleton
- Nursing Research Institute, Australian Catholic University, Darlinghurst, Australia
| | - A Holland
- University of Arizona, Tucson, AZ, USA
| | - G J Hankey
- Medical School, University of Western Australia, Perth, Australia
- Perron Institute for Neurological and Translational Science, The University of Western Australia, Nedlands, Australia
| | - J Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - D A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Fasugba O, Dale S, McInnes E, Cadilhac DA, Noetel M, Coughlan K, McElduff B, Kim J, Langley T, Cheung NW, Hill K, Pollnow V, Page K, Sanjuan Menendez E, Neal E, Griffith S, Christie LJ, Slark J, Ranta A, Levi C, Grimshaw JM, Middleton S. Evaluating remote facilitation intensity for multi-national translation of nurse-initiated stroke protocols (QASC Australasia): a protocol for a cluster randomised controlled trial. Implement Sci 2023; 18:2. [PMID: 36703172 PMCID: PMC9879239 DOI: 10.1186/s13012-023-01260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Facilitated implementation of nurse-initiated protocols to manage fever, hyperglycaemia (sugar) and swallowing difficulties (FeSS Protocols) in 19 Australian stroke units resulted in reduced death and dependency for stroke patients. However, a significant gap remains in translating this evidence-based care bundle protocol into standard practice in Australia and New Zealand. Facilitation is a key component for increasing implementation. However, its contribution to evidence translation initiatives requires further investigation. We aim to evaluate two levels of intensity of external remote facilitation as part of a multifaceted intervention to improve FeSS Protocol uptake and quality of care for patients with stroke in Australian and New Zealand acute care hospitals. METHODS A three-arm cluster randomised controlled trial with a process evaluation and economic evaluation. Australian and New Zealand hospitals with a stroke unit or service will be recruited and randomised in blocks of five to one of the three study arms-high- or low-intensity external remote facilitation or a no facilitation control group-in a 2:2:1 ratio. The multicomponent implementation strategy will incorporate implementation science frameworks (Theoretical Domains Framework, Capability, Opportunity, Motivation - Behaviour Model and the Consolidated Framework for Implementation Research) and include an online education package, audit and feedback reports, local clinical champions, barrier and enabler assessments, action plans, reminders and external remote facilitation. The primary outcome is implementation effectiveness using a composite measure comprising six monitoring and treatment elements of the FeSS Protocols. Secondary outcome measures are as follows: composite outcome of adherence to each of the combined monitoring and treatment elements for (i) fever (n=5); (ii) hyperglycaemia (n=6); and (iii) swallowing protocols (n=7); adherence to the individual elements that make up each of these protocols; comparison for composite outcomes between (i) metropolitan and rural/remote hospitals; and (ii) stroke units and stroke services. A process evaluation will examine contextual factors influencing intervention uptake. An economic evaluation will describe cost differences relative to each intervention and study outcomes. DISCUSSION We will generate new evidence on the most effective facilitation intensity to support implementation of nurse-initiated stroke protocols nationwide, reducing geographical barriers for those in rural and remote areas. TRIAL REGISTRATION ACTRN12622000028707. Registered 14 January, 2022.
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Affiliation(s)
- O Fasugba
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - S Dale
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - E McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - D A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - M Noetel
- School of Psychology, University of Queensland, Brisbane, Australia
| | - K Coughlan
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - B McElduff
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - T Langley
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - N W Cheung
- Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - K Hill
- Stroke Foundation, Sydney, New South Wales, Australia
| | - V Pollnow
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | - K Page
- St Vincent's Health Network Sydney, Sydney, New South Wales, Australia
| | | | - E Neal
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - S Griffith
- School of Psychology, University of Queensland, Brisbane, Australia
| | - L J Christie
- Allied Health Research Unit, St Vincent's Health Network, Sydney, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - J Slark
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - A Ranta
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - C Levi
- John Hunter Health and Innovation Precinct, New Lambton Heights, New South Wales, Australia
- Department of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - J M Grimshaw
- University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - S Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney & St Vincent's Hospital Melbourne & Australian Catholic University, Level 5, deLacy Building, St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
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Thayabaranathan T, Baker C, Andrew NE, Stolwyk R, Thrift AG, Carter H, Moss K, Kim J, Wallace SJ, Brogan E, Grimley R, Lannin NA, Rose ML, Cadilhac DA. Exploring dimensions of quality-of-life in survivors of stroke with communication disabilities - a brief report. Top Stroke Rehabil 2022:1-7. [PMID: 35786371 DOI: 10.1080/10749357.2022.2095087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND People with communication disabilities post-stroke have poor quality-of-life. OBJECTIVES We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. METHODS Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ2 statistics to determine differences. RESULTS Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p < .001), pain or discomfort (58% vs 39%, p = .006), self-care (46% vs 18%, p < .001), usual activities (77% vs 49%, p < .001), and mobility (68% vs 35%, p < .001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p < .001), poorer cognitive skills (thinking) (16% vs 1%, p < .001) and lower social participation (31% vs 6%, p < .001) than those without communication disabilities. CONCLUSIONS Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support.
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Affiliation(s)
- T Thayabaranathan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia
| | - C Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Speech Pathology Department, Monash Health, Victoria, Australia
| | - N E Andrew
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia
| | - R Stolwyk
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
| | - A G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - H Carter
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - K Moss
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - J Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - S J Wallace
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Queensland Aphasia Research Centre, University of Queensland, Queensland, Australia
| | - E Brogan
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - R Grimley
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - N A Lannin
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Central Clinical School, Monash University, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - M L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - D A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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4
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Phan HT, Gall SL, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley RS, Castley HC, Kilkenny MF, Cadilhac DA. Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry. Eur J Neurol 2020; 28:469-478. [PMID: 32920917 DOI: 10.1111/ene.14531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/04/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health-related quality of life (HRQoL) after stroke. METHODS We included first-ever strokes registered in the Australian Stroke Clinical Registry (2010-2014) with HRQoL assessed between 90 and 180 days after onset (EQ-5D-3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ-5D-3L were transformed into a total utility value (-0.516 'worse than death' to 1 'best' health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex. RESULTS Approximately 60% (6852/11 418) of stroke survivors had an EQ-5D-3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 years vs. men 71.2 years) and fewer could walk on admission (37.9% vs. men 46.1%, P < 0.001). Women had lower utility values than men, and the difference was explained by age and stroke severity, but not clinical care [MDadjusted = -0.039, 95% confidence interval: -0.056, -0.021]. Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years). CONCLUSIONS Stroke severity and comorbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age-sex interaction to better inform treatments for different subgroups and ensure evidence-based treatments to reduce the severity of stroke are prioritized.
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Affiliation(s)
- H T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - S L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - C L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - A G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - C S Anderson
- Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - R S Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - H C Castley
- Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - M F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - D A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Liu N, Cadilhac DA, Kilkenny MF, Liang Y. Changes in the prevalence of chronic disability in China: evidence from the China Health and Retirement Longitudinal Study. Public Health 2020; 185:102-109. [PMID: 32603874 DOI: 10.1016/j.puhe.2020.03.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Chinese adults are the biggest users of healthcare services, and understanding current trends in disability profiles is relevant to planning healthcare workforce infrastructure. We investigated the trends over time for disability and physical functional limitations from 2011 to 2015 among Chinese adults and identified the factors associated with these limitations. STUDY DESIGN We used nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS); the CHARLS participants were followed up every 2 years as they moved from work to retirement with an emphasis on their health status and functional abilities. METHODS Participants aged ≥50 years from three waves of the CHARLS were included. Data were collected on physical functioning limitations, disabilities in activities of daily living (ADLs) and disabilities in instrumental activities of daily living (IADLs). Multilevel logistic regression models were used to test for changes and factors associated with limitations and disabilities between 2011 and 2015 adjusting for sociodemographic, medical history and health measures. RESULTS There were 44,447 eligible participants (mean age: 63 years; standard deviation [SD], 9 years; 51% female). After adjustment, there was no significant increase in reporting of ADLs or IADLs in the 2015 survey compared with the 2011 survey. After adjustment, there was a 26% significant increase in reporting of physical functioning limitations in the 2015 survey compared with the 2011 survey (odds ratio: 1.26; 95% confidence interval, 1.17 to 1.35). Factors associated with ADL disability were being female, being older, minimal education, no alcohol intake in the previous year, falls, fractured hip, feeling depressed and being obese. Factors associated with IADL disabilities were being female, being older, minimal education and feeling depressed. CONCLUSIONS Chinese health agencies should consider the growing need for sufficient community services infrastructure to maximise independence, particularly in the context of ageing populations.
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Affiliation(s)
- N Liu
- Nursing Faculty, Zhuhai Campus of Zunyi Medical University, Zhuhai, People's Republic of China.
| | - D A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Public Health, Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
| | - M F Kilkenny
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Public Health, Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
| | - Y Liang
- Nanjing University of Finance and Economics, School of Public Administration, Nanjing, People's Republic of China.
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Andrew NE, Kim J, Cadilhac DA, Sundararajan V, Thrift AG, Churilov L, Lannin NA, Nelson M, Srikanth V, Kilkenny MF. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study. Int J Popul Data Sci 2019; 4:1097. [PMID: 34095531 PMCID: PMC8142961 DOI: 10.23889/ijpds.v4i1.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AIM To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. METHODS Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken. ANALYSIS The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective. CONCLUSION Completion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.
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Affiliation(s)
- NE Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - DA Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - V Sundararajan
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - AG Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - L Churilov
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - NA Lannin
- School of Allied Health, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - M Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Victoria, Australia
| | - V Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - MF Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
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Affiliation(s)
- D A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia. .,Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Australia.
| | - S S Rajan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Kim
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Australia
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Olaiya MT, Kim J, Nelson MR, Srikanth VK, Bladin CF, Gerraty RP, Fitzgerald SM, Phan T, Frayne J, Cadilhac DA, Thrift AG. Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial. Eur J Neurol 2017; 24:920-928. [DOI: 10.1111/ene.13306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M. T. Olaiya
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
| | - J. Kim
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Parkville Vic Australia
| | - M. R. Nelson
- Menzies Institute for Medical Research; Hobart Tas Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - V. K. Srikanth
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
- Menzies Institute for Medical Research; Hobart Tas Australia
| | - C. F. Bladin
- Department of Neurosciences; Box Hill Hospital; Box Hill Vic. Australia
| | - R. P. Gerraty
- Department of Medicine; Epworth Healthcare; Richmond Vic. Australia
| | - S. M. Fitzgerald
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Vic. Australia
| | - T. Phan
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
| | - J. Frayne
- Department of Neurology; Alfred Hospital; Melbourne Vic. Australia
| | - D. A. Cadilhac
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Parkville Vic Australia
| | - A. G. Thrift
- Stroke and Ageing Research; School of Clinical Sciences at Monash Health; Monash University; Clayton Vic. Australia
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Moloczij N, Mosley I, Moss KM, Bagot KL, Bladin CF, Cadilhac DA. Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis. Intern Med J 2016; 45:957-64. [PMID: 25904209 DOI: 10.1111/imj.12793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia. AIM Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations. METHODS Purposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding. RESULTS The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases. CONCLUSIONS Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme.
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Affiliation(s)
- N Moloczij
- Medical and Cognitive Research Unit, Austin Health, Heidelberg, Victoria, Australia
| | - I Mosley
- National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
| | - K M Moss
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - K L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - C F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - D A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Bladin CF, Molocijz N, Ermel S, Bagot KL, Kilkenny M, Vu M, Cadilhac DA. Victorian Stroke Telemedicine Project: implementation of a new model of translational stroke care for Australia. Intern Med J 2015; 45:951-6. [DOI: 10.1111/imj.12822] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- C. F. Bladin
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Eastern Health Clinical School; Monash University; Melbourne Victoria Australia
| | - N. Molocijz
- Medical and Cognitive Research Unit; Austin Health; Melbourne Victoria Australia
| | - S. Ermel
- Bendigo Health; Bendigo Victoria Australia
| | - K. L. Bagot
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - M. Kilkenny
- Translational Public Health Unit; Stroke and Ageing Research Centre; Department of Medicine; School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
| | - M. Vu
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - D. A. Cadilhac
- Stroke Division; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Translational Public Health Unit; Stroke and Ageing Research Centre; Department of Medicine; School of Clinical Sciences at Monash Health; Monash University; Melbourne Victoria Australia
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Kilkenny MF, Longworth M, Pollack M, Levi C, Cadilhac DA. Factors Associated With 28-Day Hospital Readmission After Stroke in Australia. Stroke 2013; 44:2260-8. [DOI: 10.1161/strokeaha.111.000531] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cadilhac DA, Kilkenny MF, Longworth M, Pollack MRP, Levi CR. Metropolitan-rural divide for stroke outcomes: do stroke units make a difference? Intern Med J 2011; 41:321-6. [DOI: 10.1111/j.1445-5994.2010.02280.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Transient ischemic attack is a medical emergency because early stroke risk after transient ischemic attack is high. Hypertension is the most important modifiable risk factor for stroke and transient ischemic attack. The aims of this review are to provide a summary of the current knowledge concerning the relationship between blood pressure and transient ischemic attack, as well as outline issues regarding diurnal variation and the potential of chronotherapy (timing medications to accord with diurnal patterns of blood pressure). There is a strong relationship between hypertension and the incidence of transient ischemic attack and the subsequent short-term risk for stroke. Ambulatory blood pressure monitoring is a reliable diagnostic and monitoring tool for hypertension and provides additional information about diurnal variation in blood pressure. Different diurnal blood pressure patterns may confer variable stroke risk. Patients with stroke commonly have abnormal diurnal blood pressure patterns and this may relate, in part, to autonomic nervous system dysfunction. However, blood pressure patterns have not been systematically studied in patients with transient ischemic attack. Blood pressure remains poorly controlled in a large proportion of patients after transient ischemic attack and under-treatment and poor adherence are important factors. Chronotherapy for blood pressure may result in more effective blood pressure control. More research is needed in this area. Hypertension is strongly associated with transient ischemic attack. Diurnal blood pressure patterns may influence subsequent stroke risk after transient ischemic attack and more evidence is needed to inform clinical practice to improve blood pressure management for transient ischemic attack patients.
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Affiliation(s)
- W W Zhang
- National Stroke Research Institute, part of Florey Neuroscience Institutes, Victoria, Australia
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Cadilhac DA, Pearce DC, Levi CR, Donnan GA. Improvements in the quality of care and health outcomes with new stroke care units following implementation of a clinician-led, health system redesign programme in New South Wales, Australia. Qual Saf Health Care 2009; 17:329-33. [PMID: 18842970 DOI: 10.1136/qshc.2007.024604] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Provision of evidence-based hospital stroke care is limited worldwide. In Australia, about a fifth of public hospitals provide stroke care units (SCUs). In 2001, the New South Wales (NSW) state government funded a clinician-led, health system redesign programme that included inpatient stroke services. Our objective was to determine the effects of this initiative for improving: (i) access to SCUs and care quality and (ii) health outcomes. DESIGN, SETTING AND PARTICIPANTS Preintervention-postintervention design (12 months prior and a minimum 6-12 months following SCU implementation). Retrospective, public hospital audit of 50 consecutive medical records per time period of stroke admissions (using International Classification of Diseases (ICD)-10 codes). Combined analyses for 15 hospitals presented. OUTCOMES Process of care indicators and patient independence (proportional odds modelling using modified Rankin scale). RESULTS Pre-programme cases (n = 703) (mean (SD) age 74 (14) years; female: 51%) and post-programme cases (n = 884) (mean age 74 (14) years; female: 49%) were comparable. Significant post-programme improvements for most process indicators were found, such as more brain imaging within 24 hours. Post-programme, access to SCUs increased 22-fold (95% CI 16.8 to 28.3). Improvement in inpatient independence at post-programme discharge was significant compared with pre-programme outcomes (proportional odds ratio 0.73, 95% CI 0.57 to 0.94; p = 0.013) when adjusted for patient clustering and case mix. CONCLUSIONS This distinctive SCU initiative was shown as effective for improving clinical practice and significantly reducing disability following stroke.
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Affiliation(s)
- D A Cadilhac
- National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia.
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Abstract
BACKGROUND There is level I evidence that management of stroke patients in stroke units (SU) improves outcomes (death and institutionalization) by approximately 20%. In Australia, there is uncertainty as to the proportion of incident cases that have access to SU. Recent national and State-based policy initiatives to increase access to SU have been taken. However, objective evidence related to SU implementation progress is lacking. The aims of the study were (i) to determine the number of SU in Australian acute public hospitals in 2004, (ii) to describe hospitals according to national SU policy criteria and (iii) to compare results to the 1999 survey to track progress. METHODS The method used in the study was a cross-sectional, postal survey technique. The participants were clinical representatives considered appropriate to describe stroke care within survey hospitals. RESULTS The outcome of the study was presence of a SU according to an accepted definition. Response rate was 261/301 (87%). Sixty-one sites (23%) had either a SU and/or a dedicated stroke team. Fifty sites claimed to have a SU (19%). New South Wales with 23 had the most number of SU. Based on policy criteria, up to 64 sites could have a SU. In 1999, there were 35 public hospitals with a SU. CONCLUSION Access to SU in Australian public hospitals remains low compared with other countries (Sweden, 70%). Implementation strategies supported by appropriate health policy to improve access are needed.
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Affiliation(s)
- D A Cadilhac
- National Stroke Research Institute, Repatriation Hospital, Heidelberg Heights, Victoria, Australia.
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