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| Associate Professor Dominique Cadilhac |
Improving the way data from patients with stroke are collected
and analysed avoids misleading comparisons of hospital performance, according
to latest research from Monash University.
Published today in the Medical Journal of Australia,
the collaborative research from Monash University and The Florey Institute of
Neuroscience and Mental Health illustrated the difficulties of ranking
hospitals according to survival outcomes if stroke severity is not taken into
account.
Lead researcher Associate Professor Dominique Cadilhac, Head
of Translational Public Health, Stroke and Ageing Research at Monash University
said hospital stroke mortality rates and hospital performance ranking can vary
widely according to the covariates included in the statistical analysis.
“Efforts to improve the quality of stroke management rely on
rigorous outcome data to avoid misleading comparisons being made between
hospitals,” Associate Professor Cadilhac said.
“In particular, stroke severity should be considered in
analysis, since it is one of the strongest predictors of mortality.”
The research team linked national death registrations with
Australian Stroke Clinical Registry data from Australian hospitals providing at
least 200 episodes of acute stroke care between 2009 and 2014.
“Risk-adjusted mortality rates (RAMRs) from models including
or not including ability to walk (a measure of stroke severity) were similar
overall and ranged between 8% and 21%,” said co-author Dr Monique Kilkenny, a senior
epidemiologist at Monash University.
However, t most importantly the rank order of hospitals
changed according to the covariates included in models, particularly for those
hospitals with the highest RAMRs—and the models with the best statistical fit
were those that included stroke severity.
“We highlight the importance of using appropriate risk
adjustment variables and methods for comparing hospital outcomes for stroke,
with particular emphasis on the need to account for stroke severity,” Associate
Professor Cadilhac said.
“When there is inadequate risk adjustment, this
inappropriately allows the interpretation that some hospitals provide
sub-standard care and thus may unfairly compromise the reputation of such hospitals
and clinicians.”
In an accompanying editorial, Professor Graeme Hankey,
professor of neurology at the University of Western Australia, wrote that the
research by Cadilhac and colleagues highlighted “the capacity of registries of
clinical quality data to inform and complement hospital and national outcome
data in the quest to measure, monitor and benchmark patient outcomes”.
“These data may facilitate the evaluation of the effects of
compliance with standards and of variations in care on patient outcomes, and
assist in the design of interventions to reduce variation that will lead to
improved outcomes.”
Associate Professor Cadilhac is also principal investigator
for the Australian Stroke Clinical Registry which operates from The Florey.
