Appropriate risk adjustment of stroke outcome data is needed for assessing and ensuring quality of care
Australia prides itself on providing high quality health care. But how is it measured? A common benchmark in hospitals is the outcome for patients as measured by routinely collected mortality data, with hospitals ranked according to their performance on this measure. However, “league tables” that rank hospitals by crude (unadjusted) mortality rates may not accurately reflect their processes and quality of care if the rates are not adjusted for other factors that can influence outcomes, such as casemix (Box).1-3
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Lee AH, Somerford PJ, Yau KK. Factors influencing survival after stroke in Western Australia. Med J Aust 2003; 179: 289-293. <MJA full text>
- 2. Heeley EL, Wei JW, Carter K, et al. Socioeconomic disparities in stroke rates and outcome: pooled analysis of stroke incidence studies in Australia and New Zealand. Med J Aust 2011; 195: 10-14. <MJA full text>
- 3. Katzan IL, Spertus J, Bettger JP, et al. Risk adjustment of ischemic stroke outcomes for comparing hospital performance: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 918-944.
- 4. Cadilhac DA, Kilkenny M, Levi CR, et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust 2017; 206: 345-350.
- 5. Kilkenny MF, Dewey HM, Sundararajan V, et al. Readmissions after stroke: linked data from the Australian Stroke Clinical Registry and hospital databases. Med J Aust 2015; 203: 102-106. <MJA full text>
- 6. Australian Commission on Safety and Quality in Health Care. Acute stroke clinical care standard. Sydney: ACSQHC, 2015. https://www.safetyandquality.gov.au/our-work/clinical-care-standards/acute-stroke-clinical-care-standard/ (accessed Feb 2017).
- 7. Cadilhac DA, Kim J, Lannin NA, et al. National stroke registries for monitoring and improving the quality of hospital care: a systematic review. Int J Stroke 2016; 11: 28-40.
- 8. Australian Commission on Safety and Quality in Health Care. Framework for Australian clinical quality registries. Sydney: ACSQHC, 2014. https://www.safetyandquality.gov.au/publications/framework-for-australian-clinical-quality-registries/ (accessed Feb 2017).
- 9. Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 2064-2089.
- 10. Shakir R, Davis S, Norrving B, et al. Revising the ICD: stroke is a brain disease. Lancet 2016; 388: 2475-2476.
No relevant disclosures.