Evidence map›Paper›PMID 31084337›Full record

Trial reportStroke2019

Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care.

Dominique A Cadilhac, Rohan Grimley, Monique F Kilkenny, Nadine E Andrew, Natasha A Lannin, Kelvin Hill, Brenda Grabsch, Christopher R Levi, Amanda G Thrift, Steven G Faux and 5 more

Abstract readClinical TrialComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Dominique A CadilhacFrom the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).
Rohan GrimleyFrom the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).
Monique F KilkennyFrom the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).
Nadine E AndrewFrom the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).
Natasha A LanninCollege of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.).
Kelvin HillClinical Services, Stroke Foundation, Melbourne, Victoria, Australia (K.H.).
Brenda GrabschStroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.).
Christopher R LeviUniversity of New South Wales, Sydney, Australia (C.R.L., S.G.F.).
Amanda G ThriftFrom the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).
Steven G FauxUniversity of New South Wales, Sydney, Australia (C.R.L., S.G.F.).
John WakefieldClinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.).
Greg CadiganClinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.).
Geoffrey A DonnanStroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.).
Sandy MiddletonNursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia (S.M.).
Craig S AndersonGeorge Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and Purpose- Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods- A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results- There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%-24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%-20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%-17%). The national score (4 indicators) improved by 17% (95% CI, 13%-20%) versus 0% change in other Australian hospitals (95% CI, -0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals ( P<0.001). Conclusions- The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.

Indexed as

Quality ImprovementQuality of Health CareAgedFemaleHumansMaleMiddle AgedProspective StudiesQueenslandStrokehealth serviceshistorically controlled studyhumansquality of health carereimbursement, incentivestroke

Identifiers

PMID31084337
PMCPMC6553516

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.