• D A Cadilhac, D C Pearce, C R Levi, G A Donnan, and Greater Metropolitan Clinical Taskforce and New South Wales Stroke Services Coordinating Committee.
• National Stroke Research Institute, Austin Health, Heidelberg Heights, Victoria, Australia. dcadilhac@nsri.org.au
• Qual Saf Health Care. 2008 Oct 1;17(5):329-33.

Background And ObjectivesProvision of evidence-based hospital stroke care is limited worldwide. In Australia, about a fifth of public hospitals provide stroke care units (SCUs). In 2001, the New South Wales (NSW) state government funded a clinician-led, health system redesign programme that included inpatient stroke services. Our objective was to determine the effects of this initiative for improving: (i) access to SCUs and care quality and (ii) health outcomes.Design, Setting And ParticipantsPreintervention-postintervention design (12 months prior and a minimum 6-12 months following SCU implementation). Retrospective, public hospital audit of 50 consecutive medical records per time period of stroke admissions (using International Classification of Diseases (ICD)-10 codes). Combined analyses for 15 hospitals presented.OutcomesProcess of care indicators and patient independence (proportional odds modelling using modified Rankin scale).ResultsPre-programme cases (n = 703) (mean (SD) age 74 (14) years; female: 51%) and post-programme cases (n = 884) (mean age 74 (14) years; female: 49%) were comparable. Significant post-programme improvements for most process indicators were found, such as more brain imaging within 24 hours. Post-programme, access to SCUs increased 22-fold (95% CI 16.8 to 28.3). Improvement in inpatient independence at post-programme discharge was significant compared with pre-programme outcomes (proportional odds ratio 0.73, 95% CI 0.57 to 0.94; p = 0.013) when adjusted for patient clustering and case mix.ConclusionsThis distinctive SCU initiative was shown as effective for improving clinical practice and significantly reducing disability following stroke.

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