Improving quality and outcomes of stroke care in hospitals: Protocol and statistical analysis plan for the Stroke123 implementation study
- 15 September 2017
- journal article
- research article
- Published by SAGE Publications in International Journal of Stroke
- Vol. 13 (1), 96-106
- https://doi.org/10.1177/1747493017730741
Abstract
The effectiveness of clinician-focused interventions to improve stroke care is uncertain. To determine whether an organizational intervention can improve the quality of stroke care over usual care. To detect an absolute 10% difference in overall performance (composite outcome), a minimum of 21 hospitals and 843 patients per group was determined. Before and after controlled design in hospitals in Queensland, Australia. Externally facilitated program (StrokeLink) using outreach workshops incorporating clinical performance feedback, patient outcomes (survival, quality of life at 90–180 days), local barrier assessments to best practice care, action planning, and ongoing support. Descriptive and multivariable analyses adjusted for patient correlations by hospital (intention-to-treat method). Concurrent implementation of financial incentives to increase stroke unit access and use of the Australian Stroke Clinical Registry for performance monitoring. Primary outcome: net change in composite score (i.e. total number of process indicators achieved divided by the sum of eligible indicators for each cohort). Secondary outcomes: change in individual indicators, change in composite score comparing hospitals that did or did not develop action plans (per-protocol analysis), impact on 90–180-day health outcomes. Sensitivity analyses: hospital self-rated status, alternate cross-sectional audit data (Stroke Foundation). To account for temporal effects, comparison of Queensland hospital performance relative to other Australian hospitals will also be undertaken. Twenty-one hospitals were recruited; however, one was unable to participate within the study time frame. Workshops were held between 11 March 2014 and 7 November 2014. Data are ready for analysis.Keywords
Funding Information
- National Health and Medical Research Council (1034415)
- Department of Health, Queensland (Partnership grant for 1034415)
- Faculty of Medicine, Nursing and Health Sciences, Monash University (Partnership grant for 1034415)
- National Stroke Foundation (Partnership grant for 1034415)
This publication has 19 references indexed in Scilit:
- Systematic review of the application of the plan–do–study–act method to improve quality in healthcareBMJ Quality & Safety, 2013
- Knowledge translation of research findingsImplementation Science, 2012
- Variations in Quality Indicators of Acute Stroke Care in 6 European CountriesStroke, 2012
- Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory studyImplementation Science, 2012
- Service Delivery and Development 2International Journal of Stroke, 2010
- Protocol and Pilot Data for Establishing the Australian Stroke Clinical RegistryInternational Journal of Stroke, 2010
- Development and assessment of the Alberta Context ToolBMC Health Services Research, 2009
- 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, AustraliaHeart, 2008
- Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challengesImplementation Science, 2008
- A Framework for Collaborative ImprovementQuality Management in Health Care, 1998