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Assessing the outcome of stroke in Australia

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Appropriate risk adjustment of stroke outcome data is needed for assessing and ensuring quality of care

Australia prides itself on providing high quality health care. But how is it measured? A common benchmark in hospitals is the outcome for patients as measured by routinely collected mortality data, with hospitals ranked according to their performance on this measure. However, “league tables” that rank hospitals by crude (unadjusted) mortality rates may not accurately reflect their processes and quality of care if the rates are not adjusted for other factors that can influence outcomes, such as casemix (Box).13

In this issue of the Journal, Cadilhac and colleagues report for the first time Australian mortality rates for stroke (30 days after hospitalisation) that are adjusted for important prognostic factors (covariates) not routinely recorded in hospital admission databases.4 The Australian Stroke Clinical Registry (AuSCR) prospectively collected clinical data on 15 951 patients who were admitted with acute stroke to 28 participating Australian hospitals (18 metropolitan and 10 rural or regional), each of which provided at least 200 episodes of stroke care between 2009 and 2014.4,5