The SPHIS Project (Southern Population Health Information System) Stroke Admissions 1999-2001 A Data Model to inform Health Policy and Prevention in a Regional Area Fabrizio Carinci Director, Centre for Health Systems Research Paul Talman Director, Stroke Unit
17
Embed
The SPHIS Project (Southern Population Health Information System) Stroke Admissions 1999-2001 A Data Model to inform Health Policy and Prevention in a.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
The SPHIS Project(Southern Population Health Information System)
Stroke Admissions 1999-2001
A Data Model to inform Health Policy and Prevention in a Regional Area
Fabrizio CarinciDirector, Centre for Health Systems Research
Paul TalmanDirector, Stroke Unit
Stroke Admissions 1st July 1998 –30th June 2001 - N=4,032 (1.1%)
Stroke Patients N=3,356
FirstAdmission
Stroke readmissionsN=676 (17%)
Yes No
X
X
X Deaths at First Admission: 316/3356 (9%)
Survivors Died at Readmission: 141/3040 (5%)
Survivors Readmitted: 1194/3040 (39%)
Survivors Never Readmitted: 1705/3040 (56%)
COHORT HISTORYSelect all admissions (any diagnosis) with same UR_NO and date of admission>date of discharge first stroke admission (N=8,287)
Admissions
30/06/2001 TIME1/06/1998
The SH 1999-2001 Stroke Cohort: Flow Chart
3-Year Overall LOS per SubjectDandenong Hospital
0
20
40
60
80
Sum
LO
S p
er S
ubje
ct
Postcodes
Geographical Variability
Stroke Patientsx 1.000(N=3324)
00-11.1-2.93-4.95.1-6.26.9-7.5
Practice Variability
LOS>26 No Yes
FREQUENCY
LOS>26 (75%) by Discharge Unit
MSGP
MDGG
SJVS
MCGA
SDVS
NCUN
SCVS
MSED
NCBS
MSGA
MDED
NJUN
MCED
MDGA
NCST
OVERALL
0 10 20 30 40 50 60 70 80 90 100
1036
716
281
262
197
121
115
91
91
63
62
50
37
31
29
3356
SH 1999-2001 - Event Rates by Department of Discharge(Mortality, Readmissions and LOS observed anywhere)
Cox Regression Results (Events / N =1,335 / 3,027)
Predictive at Subject level
SH Stroke Patients 1999-2001Outcome: Readmissions within 7 days
ODDS RATIODecreased Risk Increased Risk
Discharge Unit
History ofComorbidityAt First Stroke Admission
Stroke Diagnosis
Procedures
DischargeHospital
Predictive at Subject level
Logistic Regression Results (Events / N = 153 / 3,040)
Dandenong (3175) (2.37 ; 1.34 - 4.20)
CT Scan Intrav. (0.52 ; 0.27 - 0.98)
Hospital Transfer (3.06 ; 2.04 - 4.58)
Hampton (1.86 ; 1.04 - 3.34)
Emergency Clayton (2.25 ; 1.31 - 3.86)
Dandenong (1.07 ; 0.60 - 1.90)
Clayton (1.28 ; 0.74 - 2.19)
Cerebral Infarction (0.88 ; 0.55 -1.41)
Hemorragic (0.85 ; 0.47 - 1.56)
TIA (1.10 ; 0.69 - 1.77)
Renal (1.54 ; 0.58 - 4.10)
Diabetes (0.66 ; 0.31 - 1.40)
Circulatory (0.86 ; 0.45 - 1.64)
Heart Disease (1.62 ; 0.88 - 3.01)
Cancer (1.57 ; 0.59 - 4.15)
Respiratory (0.68 ; 0.31 - 1.46)
Male (1.04 ; 0.74 - 1.46)
Age > 65 (0.92 ; 0.61 – 1.37)
0.01 0.25 0.5 1 2 5 10
Variable (OR;95% CI)
Discharge Destination
Postcode
OutlineStrategies for Stroke Care and Prevention
Targets to reduce the impact of Overall Mortality:•Aged patients•Subjects with Hemorragic diagnoses•Assess presence of Carer at home
Targets to reduce the impact of Mortality at First Admission:•Aged patients•Subjects with Hemorragic diagnoses•Patients born in North-East Asia or North America•Discharges from Medicine Clayton
Targets to reduce the impact of Overall Readmissions:•Aged patients•Subjects with Hemorragic diagnoses•Residents in Springvale, Bentleigh East, Oakleigh
Targets to reduce the impact of Readmissions within 7 days after first discharge:•Discharges from Emergency Clayton•Residents in Dandenong
Targets to reduce the impact of Long Stay:•Patients Separated, divorced or widowed•Aged patients•Subjects with Hemorragic diagnoses•Residents in Springvale
SH All Patients 1999-2001Outcome:Overall LOS>26 (75% Stroke)
History ofComorbidityAt First Stroke Admission
Stroke Diagnosis
DischargeUnit
DischargeDestination
Procedures
Postcodes
Predictive at Subject level
Variable (HR;95% CI)
Separated/Divorced/Widow (1.44 ; 1.38 - 1.51)
Cox Regression Results (Events / N = 11,719 / 174,614)