Dwyer, M and Francis, K and Peterson, GM and Ford, K and Gall, S and Phan, H and Castley, H and Wong, L and White, R and Ryan, F and Arthurson, L and Kim, J and Cadilhac, DA and Lannin, NA, on behalf of the AuSCR Consortium, 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, 11, (4) pp. 1-8. ISSN 2044-6055 (2021) [Refereed Article]
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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.
|Item Type:||Refereed Article|
|Keywords:||accident & emergency medicine, organisation of health services, quality in health care, stroke medicine|
|Research Division:||Health Sciences|
|Research Group:||Health services and systems|
|Research Field:||Rural and remote health services|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Health inequalities|
|UTAS Author:||Dwyer, M (Dr Mitchell Dwyer)|
|UTAS Author:||Francis, K (Professor Karen Francis)|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
|UTAS Author:||Gall, S (Associate Professor Seana Gall)|
|UTAS Author:||Phan, H (Dr Hoang Phan)|
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