The SPHIS Project (Southern Population Health Information System) Stroke Admissions 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

Stroke Admissions 1 st July 1998 –30 th June 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 Stroke Cohort: Flow Chart

Geographical Variability

Practice Variability

SH Event Rates by Department of Discharge (Mortality, Readmissions and LOS observed anywhere) Mortality Readmission Overall1 ST Adm.Readm.Overall7 days ALL PATIENTSLOS > 26 Emergency Clayton Emergency Dandenong Medicine Clayton Medicine Dandenong Neurosciences (incl. NCST) NCST only Surgery Clayton Surgery Dandenong Other Mortality Readmission Overall1 st Adm.Readm.Overall7 days STROKE PATIENTSLOS > 26 Emergency Clayton Emergency Dandenong Medicine Clayton Medicine Dandenong Neurosciences Surgery Clayton Surgery Dandenong Other

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

SH Stroke Patients Outcome: Overall LOS  26

SH Stroke Patients Outcome: Overall Mortality

SH Stroke Patients Outcome: In-hospital Mortality at First Admission

SH Stroke Patients Outcome: Overall Readmissions

SH Stroke Patients Outcome: Readmissions within 7 days

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

SH All Patients Outcome:Overall LOS>26 (75% Stroke)

SH All Patients Outcome: Overall In-hospital Mortality

SH All Patients Outcome: In-hospital Mortality at First Admission

SH All Patients Outcome:Overall Readmissions

SH All Patients Outcome: Readmission within 7 days