Abstract
Background/Objectives New Zealand sets three inpatient quality metrics as benchmarks to evaluate clinical performance in the field of stroke care: admission to an organised stroke unit (80% within 24 hours of presentation), appropriate reperfusion therapy (12% of patients with ischaemic stroke), and early transfer to rehabilitation services (80% within 7 days of admission). This study assesses the performance of an Auckland hospital with respect to these targets and examines association with a number of secondary variables. Further qualitative data was collected to contexualise the secondary variables.
Methods Two hundred consecutive patients with a discharge diagnosis of stroke were selected, a sample size large enough to estimate the proportions above within a 95% confidence interval. Ethics approval was granted and locality approvals obtained. Data abstraction was performed by study investigators. Statistical analysis was performed in the R programming language.
Results Patients admitted to the Stroke Unit within 24 hours: 50.0%
Patients with ischaemic stroke who received reperfusion therapy: 16.7%
Patients transferred to Rehabilitation service within 7 days of presentation: 40.8%
A Cox Hazards model for time to discharge showed two secondary variables with significant differences.
Conclusion Although only one target was met, secondary variables data suggests complex circumstances which question the value of targets as a measure of performance. There has been mixed data regarding ethnic, gender or age-related inequity of care in acute stroke management in New Zealand, there was no evidence of this in our study. Overall, data was suggestive of an "after-hours or weekend effect".
