Age-Related Disparities in the Quality of Stroke Care and Outcomes in Rehabilitation Hospitals: The Australian National Audit

Purvis, Tara; Hubbard, Isobel J.; Cadilhac, Dominique A.; Hill, Kelvin; Watkins, Justine; Lannin, Natasha A.; Faux, Steven; Kilkenny, Monique F

doi:10.1016/j.jstrokecerebrovasdis.2021.105707

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…Younger age has previously been shown to influence the management of care received post-stroke, with younger patients more likely to receive evidence-based stroke care and information about community reintegration. 26 Authors of previous studies have also acknowledged disparities in care provision for those requiring an interpreter while in hospital. 27 , 28 Therapists have reported challenges assessing mood without subtleties of language, 29 and cultural stigmas to mental health may create additional barrier for assessing mood.…”

Section: Discussionmentioning

confidence: 99%

Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals

Hancock,

Purvis,

Thayabaranathan

et al. 2024

Clin Rehabil

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Objective Post-stroke mental health impairments are common, but under-assessed and under-treated. We aim to describe trends in the provision of mood management to patients with stroke, and describe factors associated with adoption of national mood management recommendations for stroke within Australian hospitals. Design Secondary analysis of cross-sectional data from the biennial Stroke Foundation Audit Program. Setting Participating acute (2011–2021) and rehabilitation hospitals (2012–2020) in Australia. Participants In the acute audit, 22,937 stroke cases were included from 133 hospitals. In the rehabilitation audit, 15,891 stroke cases were included from 127 hospitals. Main measures Hospital- and patient-level mood management processes. Results Among 133 acute hospitals (22,937 stroke episodes), improvements were made between 2011 and 2021 in utilization of mood screening (17% [2011], 33% [2021]; p < 0.001) and access to psychologists during hospital stay (18% [2011], 45% [2021]; p < 0.001). There was no change in access to a psychologist among those with a mood impairment ( p = 0.34). Among 127 rehabilitation hospitals (15,891 stroke episodes) improvements were observed for mood screening (35% [2012], 61% [2020]; p < 0.001), and access to a psychologist during hospital stay (38% [2012], 68% [2020]; p < 0.001) and among those with a mood-impairment (30% [2012], 50% [2020]; p < 0.001). Factors associated with receiving mood management processes included: younger age, not requiring an interpreter and longer length of stay. Conclusions Adherence to mood management recommendations has improved over 10 years within Australian hospitals. Those aged over 65, requiring an interpreter, or with shorter hospital stays are at risk of missing out on appropriate mood management.

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Section: Discussionmentioning

confidence: 99%

Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals

Hancock,

Purvis,

Thayabaranathan

et al. 2024

Clin Rehabil

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“…Attention is also drawn to the fact that older patients are less willing to actively participate in rehabilitation and often do not complete their participation in rehabilitation programs 30 , 31 . This can be of great importance when assessing the effectiveness of rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation

Wrzeciono,

Cieślik,

Kiper

et al. 2024

Sci Rep

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Virtual reality therapy has been shown to be effective in coping with psychological disorders accompanied by cardiovascular disease. Age appears to be a factor that can affect the effectiveness of psychological therapy in a virtual environment. Therefore, the aim of the study was to explore whether there are age-related differences in the effectiveness of reducing levels of depression and anxiety during a virtual reality psychological intervention implemented for rehabilitation. The study included 25 younger (< 65 years) and 25 older (65 +) patients with cardiovascular disease who participated in virtual reality therapy to cope with anxiety and depression. The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive disorders before and after intervention. Significant reductions in anxiety and depression scores after intervention were observed in both age-matched groups, and no significant differences were found between the younger and older participants. Further evaluation of patient age as a predictor of the effectiveness of psychological intervention in virtual reality did not show a significant effect of age on effectiveness in reducing anxiety and depressive disorders. The results obtained suggest that older patients benefit similarly to younger patients from psychological intervention in a virtual environment. Furthermore, age does not appear to be considered a predictor of effectiveness in reducing the level of anxiety and depression in patients with cardiovascular disease using virtual reality therapy.

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“…Indeed, there is a need for interventions that instill staff with greater care in compiling health administrative data. Furthermore, administrative data do not provide quantification of the "dose" of rehabilitation received after stroke, which is important to patient outcomes after stroke [53][54][55]. Third, there are no databases or platforms to use to compare and verify QIs.…”

Section: Discussionmentioning

confidence: 99%

Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke

et al. 2023

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Stroke is the leading global cause of permanent disability and the second leading cause of dementia within the first year of the event. Systematic quality improvement interventions such as Audit & Feedback (A&F) can monitor and improve the performance of post-stroke care in conjunction with the use of quality indicators (QIs). The scientific literature shows limited studies on quality improvement and QIs design for poststroke rehabilitation. In Italy, the National Outcomes Evaluation Programme (PNE) annually provides several QIs concerning the acute wards. On the contrary, indicators for quality assessment of post-acute stroke rehabilitation are not available nationwide. In recent years, the Italian Ministry of Health has funded a national network project, the aim of which is to provide and evaluate the effectiveness of A&F strategies in healthcare improvement. Part of this project is the development of a set of IQs for ischemic stroke rehabilitation used to conduct an A&F. In this study, we describe the design and development process of these QIs from administrative databases and report the results of the pilot test conducted on a small sample of Sicilian rehabilitation facilities, comparing them from 2019 to 2021. Feedback from the participating centers was mainly positive, and the quality indicators were found to be comprehensible and appreciated. However, the study highlighted the need for better adherence to indicators measuring processes of rehabilitation care. The set of quality indicators presented in this study, relevant to inpatient settings, could be considered a starting point on which to base quality improvement initiatives both nationally and internationally.

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Age-Related Disparities in the Quality of Stroke Care and Outcomes in Rehabilitation Hospitals: The Australian National Audit

Cited by 7 publications

References 41 publications

Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals

Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals

Exploratory analysis of the effectiveness of virtual reality in cardiovascular rehabilitation

Development of a Set of Indicators for Measuring and Improving Quality of Rehabilitation Care after Ischemic Stroke

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