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

Monique Kilkenny, Leonid Churilov and Dominique A Cadilhac
Med J Aust 2017; 207 (7): . || doi: 10.5694/mja17.00493
Published online: 2 October 2017

We thank Sutherland and colleagues for their comments on our article, and for identifying discrepant data in Box 2 and Appendix 4, now corrected.1 International guidelines explicitly refer to including stroke severity in risk adjustment.2 We maintain that stroke severity is required for reliable mortality rate comparisons. Stroke severity may modify individual hospital rankings by up to 25%.2 We have subsequently conducted new analyses using linked administrative and stroke registry data to permit inclusion of ICD-10 coded comorbidities, including calculating an Elixhauser Comorbidity Index.3 Consistent with our original findings, models with the stroke severity variable still provided the best fit for standardising mortality among the hospitals. Therefore, the registry data offer an important adjunct to work undertaken by different organisations focused on performance monitoring using administrative data, and are likely to be more acceptable to clinicians.

  • 1 Monash University, Melbourne, VIC
  • 2 Florey Institute of Neuroscience and Mental Health, Melbourne, VIC

Competing interests:

No relevant disclosures.

  • 1. Cadilhac DA, Kilkenny MF, 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. <MJA full text>
  • 2. 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.
  • 3. Kilkenny MF, Andrew N, Grimley R, et al. Does linking the Australian Stroke Clinical Registry with admissions data provide a better explanation of variability in stroke risk-adjusted mortality rates? Eur Stroke J 2017; 2: 442.
  • 4. National Health Performance Authority. Towards public reporting of standardised hospital mortality in Australia: progress report. Feb 2016. (accessed Aug 2017).
  • 5. Cadilhac DA, Kilkenny MF, Andrew NE, et al. Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia. BMC Health Serv Res 2017; 17: 212.


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