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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)


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) Article 040418. ISSN 2044-6055 (2021) [Refereed Article]

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Copyright Statement

Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

DOI: doi:10.1136/bmjopen-2020-040418


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 Details

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 Division:Health
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)
ID Code:144939
Year Published:2021
Web of Science® Times Cited:8
Deposited By:Medicine
Deposited On:2021-06-22
Last Modified:2022-12-06
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