John Hunter Hospital Campus

Australia

John Hunter Hospital Campus

Australia
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Cadilhac D.A.,Monash University | Cadilhac D.A.,Florey Institute of Neuroscience and Mental Health | Kilkenny M.F.,Monash University | Kilkenny M.F.,Florey Institute of Neuroscience and Mental Health | And 25 more authors.
Medical Journal of Australia | Year: 2017

Objectives: Hospital data used to assess regional variability in disease management and outcomes, including mortality, lack information on disease severity. We describe variance between hospitals in 30-day risk-adjusted mortality rates (RAMRs) for stroke, comparing models that include or exclude stroke severity as a covariate. Design: Cohort design linking Australian Stroke Clinical Registry data with national death registrations. Multivariable models using recommended statistical methods for calculating 30-day RAMRs for hospitals, adjusted for demographic factors, ability to walk on admission, stroke type, and stroke recurrence. Setting: Australian hospitals providing at least 200 episodes of acute stroke care, 2009e2014. Main outcome measures: Hospital RAMRs estimated by different models. Changes in hospital rank order and funnel plots were used to explore variation in hospital-specific 30-day RAMRs; that is, RAMRs more than three standard deviations from the mean. Results: In the 28 hospitals reporting at least 200 episodes of care, there were 16 218 episodes (15 951 patients;median age, 77 years; women, 46%; ischaemic strokes, 79%). RAMRs from models not including stroke severity as a variable ranged between 8% and 20%; RAMRs from models with the best fit, which included ability to walk and stroke recurrence as variables, ranged between 9% and 21%. The rank order of hospitals changed according to the covariates included in the models, particularly for those hospitals with the highest RAMRs. Funnel plots identified significant deviation from the mean overall RAMR for two hospitals, including one with borderline excess mortality. Conclusions: Hospital stroke mortality rates and hospital performance ranking may vary widely according to the covariates included in the statistical analysis. © 2017 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.


Clark K.,Calvary Materials Newcastle | Clark K.,University of Newcastle | Byfieldt N.,Calvary Materials Newcastle | Green M.,Clinical Excellence Commission | And 3 more authors.
Australian Health Review | Year: 2014

The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering people's wishes while always treating people with dignity and respect. This work describes a gap analysis undertaken to explore if issues defined as important by people facing imminent death would have been addressed by usual care of the dying in general hospital wards. The specific issues examined included the documentation that was available to define that this person was likely to die soon and how engaged the person dying seemed to be in discussions, how the person was monitored to ensure distressing symptoms were addressed when necessary and what investigations were considered necessary after the time the person was identified as dying. Although retrospective, the review highlights that usual care would not meet people's wishes, suggesting that care of the dying would not meet the ACQSHC standard entitled 'Partnering with consumers'. An alternative model is needed. What is known about the topic? The majority of Australians die in acute hospitals. Despite this, there is no agreed Australian evidence-based, clinical standard to define best practice as to what constitutes quality care for these people. What does this paper add? This paper explores whether particular specific patient-centred needs defined in the end of life literature would have been meet by usual care delivered to people dying in general medical and surgical wards. What are the implications for practitioners? Although many Australians would prefer a home death, the majority of deaths still occur in hospital. In this context, this work articulates that there is a need to consider the wishes and needs of patients when considering care at the end of life in line with Australian standards. However, this is only one aspect of care and further work is needed to consider other aspects of care including the quality of prescribing for dying people. © AHHA 2014.

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