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Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

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Cadilhac, DA, Andrew, NE, Stroil Salama, E, Hill, K, Middleton, S, Horton, E, Meade, I, Kuhle, S, Nelson, MR ORCID: 0000-0001-9941-7161 and Grimley, R 2017 , 'Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study' , BMJ Open, vol. 7, no. 8 , pp. 1-10 , doi: 10.1136/ bmjopen-2017-016010.

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Abstract

Objective: Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before-after observational study design.Setting: Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a 'top-ranked' hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers.Participants: Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack.Intervention: A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning.Primary and Secondary Outcome Measures: Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability).Results: Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, pConclusion: Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale.

Item Type: Article
Authors/Creators:Cadilhac, DA and Andrew, NE and Stroil Salama, E and Hill, K and Middleton, S and Horton, E and Meade, I and Kuhle, S and Nelson, MR and Grimley, R
Keywords: change management, clinical audit, quality in health care, stroke
Journal or Publication Title: BMJ Open
Publisher: BMJ Group
ISSN: 2044-6055
DOI / ID Number: 10.1136/ bmjopen-2017-016010
Copyright Information:

© Article author(s) 2017. Licensed under Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license (http://creativecommons.org/licenses/by-nc/4.0/)

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