Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Monday, May 8, 2017

Improving stroke data analysis provides more reliable comparisons of hospital performance

Why would hospitals want to measure stroke results? In doing so they would be forced to recognize how bad they are at stroke and expend intellectual capital and money to improve them. That might show how fucking incompetent they are at what they are doing.
https://medicalxpress.com/news/2017-05-analysis-reliable-comparisons-hospital.html


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 Monash University Associate Professor Dominique Cadilhac who is Head of Translational Public Health, Stroke and Ageing Research 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 percent and 21 per cent," said co-author and Monash senior epidemiologist Dr Monique Kilkenny.
However, 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."
More information: Dominique A Cadilhac et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR), The Medical Journal of Australia (2017). DOI: 10.5694/mja16.00525

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 Monash University Associate Professor Dominique Cadilhac who is Head of Translational Public Health, Stroke and Ageing Research said hospital stroke mortality rates and 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 (RAMRs) from models including, or not including, ability to walk (a measure of stroke severity) were similar overall and ranged between 8 percent and 21 per cent," said co-author and Monash senior epidemiologist Dr Monique Kilkenny.
However, 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 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 and national outcome data in the quest to measure, monitor and benchmark ."
"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."
More information: Dominique A Cadilhac et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR), The Medical Journal of Australia (2017). DOI: 10.5694/mja16.00525



Read more at: https://medicalxpress.com/news/2017-05-analysis-reliable-comparisons-hospital.html#jCp

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