1. 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

2. Stroke Admissions 1 st July 1998 –30 th June 2001 - N=4,032 (1.1%) Stroke Patients N=3,356 First Admission Stroke readmissions N=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 HISTORY Select 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 TIME 1/06/1998 The SH 1999-2001 Stroke Cohort: Flow Chart

3. Geographical Variability

4. Practice Variability

5. SH 1999-2001 - Event Rates by Department of Discharge (Mortality, Readmissions and LOS observed anywhere) Mortality Readmission Overall1 ST Adm.Readm.Overall7 days ALL PATIENTSLOS > 26 Emergency Clayton2.91.90.61.3 28.48.5 Emergency Dandenong3.02.00.91.126.96.1 Medicine Clayton31.016.98.18.851.54.4 Medicine Dandenong18.413.16.07.144.93.3 Neurosciences (incl. NCST)15.16.14.31.832.73.5 NCST only9.610.59.90.63.50.5 Surgery Clayton15.88.43.94.543.82.5 Surgery Dandenong16.47.63.84.838.22.8 Other6.31.90.81.127.23.2 Mortality Readmission Overall1 st Adm.Readm.Overall7 days STROKE PATIENTSLOS > 26 Emergency Clayton7.79.04.4 4.635.511.6 Emergency Dandenong8.24.23.11.130.52.1 Medicine Clayton41.340.521.318.659.35.1 Medicine Dandenong31.718.26.411.856.85.0 Neurosciences27.314.310.83.543.54.4 Surgery Clayton14.24.4-4.439.63.3 Surgery Dandenong3.23.2-3.225.84.8 Other24.712.97.55.436.74.6

6. Outcomes= Subject-Level Adjustments + Practice-Level Adjustments + Subject Level Covariates + Practice-Level Risk Covariates + Population-Level Factors Modelling

7. SH Stroke Patients 1999-2001 Outcome: Overall LOS  26

8. SH Stroke Patients 1999-2001 Outcome: Overall Mortality

9. SH Stroke Patients 1999-2001 Outcome: In-hospital Mortality at First Admission

10. SH Stroke Patients 1999-2001 Outcome: Overall Readmissions

11. SH Stroke Patients 1999-2001 Outcome: Readmissions within 7 days

12. Outline Strategies 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

13. SH All Patients 1999-2001 Outcome:Overall LOS>26 (75% Stroke)

14. SH All Patients 1999-2001 Outcome: Overall In-hospital Mortality

15. SH All Patients 1999-2001 Outcome: In-hospital Mortality at First Admission

16. SH All Patients 1999-2001 Outcome:Overall Readmissions

17. SH All Patients 1999-2001 Outcome: Readmission within 7 days