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

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The SPHIS Project(Southern Population Health
Information System)Stroke Admissions
1999-2001A Data Model to inform Health Policy
and Prevention in a Regional AreaFabrizio
CarinciDirector, Centre for Health Systems
ResearchPaul TalmanDirector, Stroke Unit
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The SH 1999-2001 Stroke Cohort Flow Chart
Stroke Admissions 1st July 1998 30th June 2001 -
N4,032 (1.1)
First Admission
Yes
No
Stroke Patients N3,356
Stroke readmissions N676 (17)
COHORT HISTORY Select all admissions (any
diagnosis) with same UR_NO and date of
admissiongtdate of discharge first stroke
admission (N8,287)
X
Deaths at First Admission 316/3356 (9)
X
Survivors Died at Readmission 141/3040 (5)
Patients
Survivors Readmitted 1194/3040 (39)
X
Survivors Never Readmitted 1705/3040 (56)
Admissions
30/06/2001
1/06/1998
TIME
3
Geographical Variability
4
Practice Variability
5
SH 1999-2001 - Event Rates by Department of
Discharge(Mortality, Readmissions and LOS
observed anywhere)
6
Modelling
Outcomes Subject-Level Adjustments
Practice-Level Adjustments Subject Level
Covariates Practice-Level Risk Covariates
Population-Level Factors
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SH Stroke Patients 1999-2001Outcome Overall
LOS³26
8
SH Stroke Patients 1999-2001Outcome Overall
Mortality
9
SH Stroke Patients 1999-2001Outcome In-hospital
Mortality at First Admission
10
SH Stroke Patients 1999-2001Outcome Overall
Readmissions
11
SH Stroke Patients 1999-2001Outcome
Readmissions within 7 days
12
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

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SH All Patients 1999-2001OutcomeOverall LOSgt26
(75 Stroke)
14
SH All Patients 1999-2001Outcome Overall
In-hospital Mortality
15
SH All Patients 1999-2001Outcome In-hospital
Mortality at First Admission
16
SH All Patients 1999-2001OutcomeOverall
Readmissions
17
SH All Patients 1999-2001Outcome Readmission
within 7 days