Open AccessPre-Hospital Factors Influencing the Provision of Acute Care for Patients with Stroke: Preliminary Findings from A State-Wide Data Linkage Study
Author(s) -
Amminadab L Eliakundu,
Karen Smith,
Monique F Kilkenny,
Amanda G. Thrift,
Kathleen L. Bagot,
Emily Andrew,
Christopher Bladin,
Dominique A. Cadilhac
Publication year - 2020
Publication title -
international journal of population data science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 7
ISSN - 2399-4908
DOI - 10.23889/ijpds.v5i5.1548
Subject(s) - medicine , thrombolysis , stroke (engine) , logistic regression , emergency medicine , medical record , acute stroke , odds , emergency department , odds ratio , medical emergency , record linkage , emergency medical services , population , myocardial infarction , mechanical engineering , environmental health , psychiatry , engineering
Improvement in access to reperfusion therapy and reductions in treatment delays requires coordination of multiple systems and services including a well-organised and streamlined pre-hospital care system.
Objectives and ApproachOur objective is to examine pre-hospital and hospital factors that influence long-term outcomes in patients with stroke. We linked and merged patient-level data from the Australian Stroke Clinical Registry (AuSCR) to Ambulance Victoria (AV), hospital administrative datasets (Victorian Admitted Episodes Data; VAED) and emergency department data (Victorian Emergency Minimum Dataset; VEMD) using probabilistic, iterative methods. Logistic regression models were used to determine clinical factors associated with access to evidence-based treatments.
Results7,373 episodes in the AuSCR were available for linkage, of which 4,569 (62%) were matched with AV records (58% male, median age 72 years). Of these 4,569 matched records, 4,159 (58% male, median age 73 years) had a record in the VAED or VEMD. Stroke or transient ischaemic attack was suspected for 68% of patients by paramedics based on the AV data. Highest transport priority was used for 64% of patients. Patients suspected of stroke by paramedics were more likely to be treated in stroke unit (unadjusted odds ratio, 1.72; 1.47, 2.01) and more likely to receive thrombolysis if ischaemic stroke (unadjusted odd ratio: 4.64, 3.47, 6.20).
Conclusion/ImplicationsLinkage of these administrative data with the AuSCR provide the opportunity to interrogate a range of questions to inform policy and practice of acute stroke care. Future analyses will investigate patient (such as comorbidities), clinical and system factors that influence provision of evidence-based care for patients with stroke and whether these influence outcomes at 6 months after stroke.