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)
Joosup Kim,
Dominique A Cadilhac,
Richard White,
Natasha A Lannin,
Fiona Ryan,
Karen Ford,
Mitchell Dwyer,
Karen Francis,
Gregory M Peterson,
Seana Gall,
Hoang Phan,
Helen Castley,
Lillian Wong,
Lauren Arthurson
Affiliations
Joosup Kim
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Dominique A Cadilhac
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Richard White
Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
Natasha A Lannin
Occupational Therapy Department, Alfred Hospital, Melbourne, Victoria, Australia
Fiona Ryan
Orange and Bathurst Health Services, NSW Health, North Sydney, New South Wales, Australia
Karen Ford
School of Nursing, University of Tasmania, Hobart, Tasmania, Australia
Mitchell Dwyer
Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
Karen Francis
School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
Gregory M Peterson
18 School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
Seana Gall
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Hoang Phan
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Helen Castley
Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
Lillian Wong
Princess Alexandra Hospital, QLD Health, Woolloongabba, Queensland, Australia
Lauren Arthurson
Inpatient Rehabilitation, Echuca Regional Health, Echuca, Victoria, Australia
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.
