Stroke in the West Midlands Stacey Croft, WMPHO Kristina Routh, DH (WM) Helen Carter, NHS WM
Jan 15, 2016
Stroke in the West Midlands
Stacey Croft, WMPHO
Kristina Routh, DH (WM)
Helen Carter, NHS WM
What is covered in the KHD chapter?
• What is stroke?• Mortality• Morbidity
– Hospital Admissions– Prevalence
• Quality of care markers – Primary Care• Quality of care markers – Secondary Care
What is stroke?Disruption of blood supply to brain – ‘brain attack’.• Two main types
– ischaemic (80%), haemorrhagic (15%)
• Sudden onset– e.g. weakness of limbs, loss of speech, unconsciousness
• Transient ischaemic attack (TIA) lasts <24 hrs• 110,000 people a year in UK have a stroke• Around 30% die within a year• Single largest cause of disability in the UK• Risk factors include
– age, raised bp, smoking, alcohol, lack of exercise, atrial fibrillation, obesity, previous TIA.
Mortality
• Age profile
• PCTs map mortality
• Association with deprivation
0
1000
2000
3000
4000
50000-
4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age
Nu
mb
er o
f D
eath
s
0
500
1000
1500
2000
2500
Ag
e Sp
ecific Rate
(per 100,000)
Count Males Count Females Rate Males Rate Females
Data Source: ONSAnalysis: WMPHO
Age Profile of Stroke (ICD10 I60-I69) Mortality in the West Midlands, deaths registered 2004-06
Under 75’s Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Primary Care Organisation, deaths registered 2004-06
Mortality
95% Confidence Interval Persons Linear (Persons)
Under 75s
R2 = 0.97
0
5
10
15
20
25
30
35
1 (most
deprived)
2 3 4 5 (least
deprived)IMD 2007(England Rank Quintiles)
Dir
ectl
y A
ge
& S
ex S
tan
dar
dis
ed R
ate
(per
100
,000
)
75+
0
200
400
600
800
1000
1200
1 (most
deprived)
2 3 4 5 (least
deprived)IMD 2007(England Rank Quintiles)
Dir
ectl
y A
ge
& S
ex S
tan
dar
dis
ed R
ate
(per
100
,000
)
Data Source:ONS, DCLGAnalysis:WMPHO
Stroke (ICD10 I60-I69) Mortality Rates in the West Midlands by Deprivation, deaths registered 2004-06
Morbidity
• Hospital admissions– Emergency admissions by PCT
• Prevalence– Quality Outcomes Framework (QOF)
Under 75’s Stroke (ICD10 I60-I69) Emergency Admission Rates in the West Midlands by Primary Care Organisation, financial year 2006/07
Morbidity Emergency Admissions
Unadjusted Prevalence Rates of Stroke and TIA (STR1), in the West Midlands by Primary Care Trust, Financial Year 2007/08
MorbidityQOF Prevalence
Quality of care markers
• Primary care – QOF
• Secondary care– Sentinel Audit
Primary care quality markers
• Further investigations (Stroke 11)
• Blood pressure (Stroke 6)
• Cholesterol (Stroke 8)
• Anti-coagulation (Stroke 12)
70%
75%
80%
85%
90%
95%
100%N
orth
Sta
fford
shire
Wol
verh
am
pto
nC
ity
Her
efor
dsh
ire
Sto
ke-o
n-T
rent
Dud
ley
Cov
entr
y
Tel
ford
& W
reki
n
Shr
ops
hire
Cou
nty
Sou
thB
irmin
gham
Wal
sall
Sou
thS
taffo
rdsh
ire
San
dwe
ll
Birm
ingh
am E
ast
& N
ort
h
Hea
rt o
fB
irmin
gham
Wor
cest
ers
hire
War
wic
kshi
re
Sol
ihul
l
Primary Care Organisation
95% Confidence Interval % West Midlands
Data Source: QOF STROKE11Analysis: WMPHO
QoF Stroke 11: Referral for further investigations 2007/08 financial year by PCT
Secondary care quality markers
Sentinel Audit: Royal College of Physicians
• Phase 1– organisation of care. 10 domains
• Phase 2– process of care. 12 Key Standards
Conclusions
• Higher than national mortality– More stroke?– More likely to die?
• Quality indicators vary
• Expect changes following introduction of National Stroke Strategy