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Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR).

Abstract 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.
PMID
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Authors

Mayor MeshTerms

Hospital Mortality

Keywords
Journal Title the medical journal of australia
Publication Year Start




PMID- 28446116
OWN - NLM
STAT- MEDLINE
DA  - 20170427
DCOM- 20170502
LR  - 20170502
IS  - 1326-5377 (Electronic)
IS  - 0025-729X (Linking)
VI  - 206
IP  - 8
DP  - 2017 May 01
TI  - Risk-adjusted hospital mortality rates for stroke: evidence from the Australian
      Stroke Clinical Registry (AuSCR).
PG  - 345-350
AB  - 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, 2009-2014. 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.
FAU - Cadilhac, Dominique A
AU  - Cadilhac DA
AD  - Monash University, Melbourne, VIC [email protected]
FAU - Kilkenny, Monique F
AU  - Kilkenny MF
AD  - Monash University, Melbourne, VIC.
FAU - Levi, Christopher R
AU  - Levi CR
AD  - John Hunter Hospital Campus, Newcastle, NSW.
FAU - Lannin, Natasha A
AU  - Lannin NA
AD  - La Trobe University, Melbourne, VIC.
FAU - Thrift, Amanda G
AU  - Thrift AG
AD  - Monash University, Melbourne, VIC.
FAU - Kim, Joosup
AU  - Kim J
AD  - Monash University, Melbourne, VIC.
FAU - Grabsch, Brenda
AU  - Grabsch B
AD  - Florey Institute of Neuroscience and Mental Health, Melbourne, VIC.
FAU - Churilov, Leonid
AU  - Churilov L
AD  - Florey Institute of Neuroscience and Mental Health, Melbourne, VIC.
FAU - Dewey, Helen M
AU  - Dewey HM
AD  - Eastern Health Clinical School, Monash University, Melbourne, VIC.
FAU - Hill, Kelvin
AU  - Hill K
AD  - Stroke Foundation, Melbourne, VIC.
FAU - Faux, Steven G
AU  - Faux SG
AD  - St Vincent's Hospital, Sydney, NSW.
FAU - Grimley, Rohan
AU  - Grimley R
AD  - Sunshine Coast Clinical School, University of Queensland, Birtinya, QLD.
FAU - Castley, Helen
AU  - Castley H
AD  - Royal Hobart Hospital, Hobart, TAS.
FAU - Hand, Peter J
AU  - Hand PJ
AD  - Royal Melbourne Hospital, Melbourne, VIC.
FAU - Wong, Andrew
AU  - Wong A
AD  - Royal Brisbane and Women's Hospital, Brisbane, QLD.
FAU - Herkes, Geoffrey K
AU  - Herkes GK
AD  - Royal North Shore Hospital, Sydney, NSW.
FAU - Gill, Melissa
AU  - Gill M
AD  - Armidale Rural Referral Hospital, Hunter New England Local Health District,
      Armidale, NSW.
FAU - Crompton, Douglas
AU  - Crompton D
AD  - Northern Health, Melbourne, VIC.
FAU - Middleton, Sandy
AU  - Middleton S
AD  - St Vincent's Health Australia (Sydney), Sydney, NSW.
FAU - Donnan, Geoffrey A
AU  - Donnan GA
AD  - Florey Institute of Neuroscience and Mental Health, Melbourne, VIC.
FAU - Anderson, Craig S
AU  - Anderson CS
AD  - The George Institute for Global Health, Sydney, NSW.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - Australia
TA  - Med J Aust
JT  - The Medical journal of Australia
JID - 0400714
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Australia
MH  - Female
MH  - *Hospital Mortality
MH  - Hospitals/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Models, Statistical
MH  - Outcome Assessment (Health Care)
MH  - Prospective Studies
MH  - Quality of Health Care/*standards
MH  - Registries
MH  - Risk Adjustment
MH  - Stroke/*mortality
EDAT- 2017/04/28 06:00
MHDA- 2017/05/04 06:00
CRDT- 2017/04/28 06:00
PHST- 2016/05/03 [received]
PHST- 2016/10/11 [accepted]
AID - 10.5694/mja16.00525 [pii]
PST - ppublish
SO  - Med J Aust. 2017 May 1;206(8):345-350.

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