23 results on '"Cadigan, Greg"'
Search Results
2. Impact of pay-for-performance for stroke unit access on mortality in Queensland, Australia: an interrupted time series analysis
- Author
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Grimley, Rohan S., Collyer, Taya A., Andrew, Nadine E., Dewey, Helen M., Horton, Eleanor S., Cadigan, Greg, and Cadilhac, Dominique A.
- Published
- 2023
- Full Text
- View/download PDF
3. Fracture Risk Increases After Stroke or Transient Ischemic Attack and Is Associated With Reduced Quality of Life
- Author
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Dalli, Lachlan L., primary, Borschmann, Karen, additional, Cooke, Shae, additional, Kilkenny, Monique F., additional, Andrew, Nadine E., additional, Scott, David, additional, Ebeling, Peter R., additional, Lannin, Natasha A., additional, Grimley, Rohan, additional, Sundararajan, Vijaya, additional, Katzenellenbogen, Judith M., additional, Cadilhac, Dominique A., additional, Anderson, Craig, additional, Donnan, Geoffrey, additional, Levi, Christopher, additional, Thrift, Amanda, additional, Middleton, Sandy, additional, Faux, Steven, additional, Denisenko, Sonia, additional, Dewey, Helen, additional, Godecke, Erin, additional, Katzenellenbogen, Judy, additional, Lalor, Erin, additional, Lee, Andrew, additional, Longworth, Mark, additional, Cadigan, Greg, additional, Dilworth, Cindy, additional, Price, Chris, additional, Hill, Kelvin, additional, Page, Matthew, additional, Egan, Jen, additional, Grabsch, Brenda, additional, Kung, Francis, additional, Moss, Karen, additional, Street, Steven, additional, Tod, Emma, additional, Gibbs, Adele, additional, Purvis, Tara, additional, and Reyneke, Megan, additional
- Published
- 2023
- Full Text
- View/download PDF
4. Nurse-Initiated Acute Stroke Care in Emergency Departments: The Triage, Treatment, and Transfer Implementation Cluster Randomized Controlled Trial
- Author
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Middleton, Sandy, Dale, Simeon, Cheung, N. Wah, Cadilhac, Dominique A., Grimshaw, Jeremy M., Levi, Chris, McInnes, Elizabeth, Considine, Julie, McElduff, Patrick, Gerraty, Richard, Craig, Louise Eisten, Schadewaldt, Verena, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark, Ward, Jeanette, and D’Este, Catherine
- Published
- 2019
- Full Text
- View/download PDF
5. Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia
- Author
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Kim, Joosup, primary, Grimley, Rohan, additional, Kilkenny, Monique F, additional, Cadigan, Greg, additional, Johnston, Trisha, additional, Andrew, Nadine E, additional, Thrift, Amanda G, additional, Lannin, Natasha A, additional, Sundararajan, Vijaya, additional, and Cadilhac, Dominique A, additional
- Published
- 2022
- Full Text
- View/download PDF
6. Supplemental Material - Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia
- Author
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Kim, Joosup, Grimley, Rohan, Kilkenny, Monique F, Cadigan, Greg, Johnston, Trisha, Andrew, Nadine E, Thrift, Amanda G, Lannin, Natasha A, Sundararajan, Vijaya, and Cadilhac, Dominique A
- Subjects
111708 Health and Community Services ,111799 Public Health and Health Services not elsewhere classified ,FOS: Health sciences - Abstract
Supplemental material for Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia by Joosup Kim, Rohan Grimley, Monique F Kilkenny, Greg Cadigan, Trisha Johnston, Nadine E Andrew, Amanda G Thrift, Natasha A Lannin, Vijaya Sundararajan, Dominique A Cadilhac in Health Information Management Journal.
- Published
- 2022
- Full Text
- View/download PDF
7. Utility of the Hospital Frailty Risk Score Derived From Administrative Data and the Association With Stroke Outcomes
- Author
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Kilkenny, Monique F., primary, Phan, Hoang T., additional, Lindley, Richard I., additional, Kim, Joosup, additional, Lopez, Derrick, additional, Dalli, Lachlan L., additional, Grimley, Rohan, additional, Sundararajan, Vijaya, additional, Thrift, Amanda G., additional, Andrew, Nadine E., additional, Donnan, Geoffrey A., additional, Cadilhac, Dominique A., additional, Anderson, Craig, additional, Bernhardt, Julie, additional, Bew, Paul, additional, Bladin, Christopher, additional, Cadigan, Greg, additional, Castley, Helen, additional, Lee, Andrew, additional, Mackay, Mark, additional, Martyn, Sandra, additional, McNeil, John, additional, Middleton, Sandy, additional, Pollack, Michael, additional, Simcocks, Mark, additional, Simmonds, Frances, additional, Dewey, Helen, additional, Faux, Steven, additional, Hill, Kelvin, additional, Levi, Christopher, additional, Price, Christopher, additional, Bambery, Pradeep, additional, Bates, Tim, additional, Beltrame, Carolyn, additional, Blacker, David, additional, Butler, Ernie, additional, Butler, Sean, additional, Crompton, Douglas, additional, Crosby, Vanessa, additional, De Wytt, Carolyn, additional, Douglas, David, additional, Dunlop, Martin, additional, Easton, Paula, additional, Ermel, Sharan, additional, Gange, Nisal, additional, Geraghty, Richard, additional, Gill, Melissa, additional, Hall, Graham, additional, Hand, Peter, additional, Herkes, Geoffrey, additional, Hines, Karen, additional, Hishon, Francis, additional, Hughes, James, additional, Iedema, Joel, additional, Jude, Martin, additional, Kraemer, Thomas, additional, Laird, Paul, additional, Madden, Johanna, additional, Mahaffey, Graham, additional, Milosevic, Suzana, additional, O’Brien, Peter, additional, Read, Stephen, additional, Rowe, Kristen, additional, Ryan, Fiona, additional, Sabet, Arman, additional, Saines, Noel, additional, Salud, Eva, additional, Siller, Amanda, additional, Staples, Christopher, additional, White, Richard, additional, Wong, Andrew, additional, Armstrong, Robin, additional, Churilov, Leonid, additional, Dias, Alison, additional, Gibbs, Adele, additional, Grabsch, Brenda, additional, Kung, Francis, additional, Lim, Joyce, additional, Moss, Karen, additional, Paice, Kate, additional, Salama, Enna, additional, Small, Sabrina, additional, Stojanovic, Renee, additional, Street, Steven, additional, Tod, Emma, additional, and Wallis, Kasey, additional
- Published
- 2021
- Full Text
- View/download PDF
8. Immune activation in the peripheral blood of patients with acute ischemic stroke
- Author
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Yan, Jun, Greer, Judith M., Etherington, Kellie, Cadigan, Greg P., Cavanagh, Helen, Henderson, Robert D., O'Sullivan, John D., Pandian, Jeyaraj D., Read, Stephen J., and McCombe, Pamela A.
- Published
- 2009
- Full Text
- View/download PDF
9. Supplementary_Table_2 – Supplemental material for Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study
- Author
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Grimley, Rohan S, Rosbergen, Ingrid CM, Gustafsson, Louise, Horton, Eleanor, Green, Theresa, Cadigan, Greg, Kuys, Suzanne, Andrew, Nadine E, and Cadilhac, Dominique A
- Subjects
FOS: Clinical medicine ,110604 Sports Medicine ,FOS: Health sciences ,110904 Neurology and Neuromuscular Diseases ,110314 Orthopaedics - Abstract
Supplemental material, Supplementary_Table_2 for Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study by Rohan S Grimley, Ingrid CM Rosbergen, Louise Gustafsson, Eleanor Horton, Theresa Green, Greg Cadigan, Suzanne Kuys, Nadine E Andrew and Dominique A Cadilhac in Clinical Rehabilitation
- Published
- 2020
- Full Text
- View/download PDF
10. Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study
- Author
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Grimley, Rohan S, primary, Rosbergen, Ingrid CM, additional, Gustafsson, Louise, additional, Horton, Eleanor, additional, Green, Theresa, additional, Cadigan, Greg, additional, Kuys, Suzanne, additional, Andrew, Nadine E, additional, and Cadilhac, Dominique A, additional
- Published
- 2020
- Full Text
- View/download PDF
11. Cluster‐Randomized Trial of Thrombolysis Implementation Support in Metropolitan and Regional Australian Stroke Centers: Lessons for Individual and Systems Behavior Change
- Author
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Levi, Christopher R., primary, Attia, John A., additional, D'Este, Cate, additional, Ryan, Annika E., additional, Henskens, Frans, additional, Kerr, Erin, additional, Parsons, Mark W., additional, Sanson‐Fisher, Robert W., additional, Bladin, Christopher F., additional, Lindley, Richard I., additional, Middleton, Sandy, additional, Paul, Christine L., additional, Anderson, Craig, additional, Ang, Tim, additional, Bivard, Andrew, additional, Cadigan, Greg, additional, Celestino, Sherisse, additional, Coles, Tim, additional, Corbett, Alistair, additional, Dark, Lisa, additional, Day, Susan, additional, Dennett, Jennifer, additional, Donnan, Geoffrey, additional, Evans, Malcolm, additional, Fernando, Kavisha, additional, Geraghty, Richard, additional, Gerraty, Richard, additional, Grady, Alice, additional, Grimley, Rohan, additional, Gu, Jason, additional, Hankey, Graeme J., additional, Hoffman, Kim, additional, Hughes, James, additional, Ip, Jerome, additional, Jenkins, Bronwyn, additional, Jones, Mark, additional, Jude, Martin, additional, Kaauwai, Lara, additional, Kanard, Malcolm, additional, Kinchington, Matthew, additional, Krause, Martin, additional, Kuhle, Sarah, additional, Levy, Stanley, additional, Longworth, Mark, additional, Macdonald, Beverley, additional, Mackey, Elizabeth, additional, Mandaleson, Krishna, additional, Miteff, Ferdi, additional, Mohr, Katherine, additional, Moore, Stephen, additional, Morris, Kristy, additional, O'Brien, Elizabeth, additional, Oldmeadow, Christopher, additional, Paddock, Bruce, additional, Parrey, Kim, additional, Peake, Rachel, additional, Russell, Michelle, additional, Stevenson, Margaret, additional, Taneja, Sanjeev, additional, Teasdale, Natalie, additional, Terpening, Zoe, additional, Van Berkel, Anne, additional, Watson, John D. G., additional, Weiner, Yolande, additional, Wijeratne, Tissa, additional, Wilson, Alison, additional, and Wolfe, Nigel, additional
- Published
- 2020
- Full Text
- View/download PDF
12. Supplemental_Material_ – Supplemental material for Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia
- Author
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Grimley, Rohan S, Rosbergen, Ingrid CM, Gustaffson, Louise, Horton, Eleanor, Green, Theresa, Cadigan, Greg, Cadilhac, Dominique A, and Kuys, Suzanne
- Subjects
FOS: Clinical medicine ,110604 Sports Medicine ,FOS: Health sciences ,110904 Neurology and Neuromuscular Diseases ,110314 Orthopaedics - Abstract
Supplemental material, Supplemental_Material_ for Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia by Rohan S Grimley, Ingrid CM Rosbergen, Louise Gustaffson, Eleanor Horton, Theresa Green, Greg Cadigan, Dominique A Cadilhac and Suzanne Kuys in Clinical Rehabilitation
- Published
- 2019
- Full Text
- View/download PDF
13. Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia
- Author
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Grimley, Rohan S, primary, Rosbergen, Ingrid CM, additional, Gustaffson, Louise, additional, Horton, Eleanor, additional, Green, Theresa, additional, Cadigan, Greg, additional, Cadilhac, Dominique A, additional, and Kuys, Suzanne, additional
- Published
- 2019
- Full Text
- View/download PDF
14. Process Evaluation of The T3 Trial : a Nurse-initiated intervention To Improve Stroke Care in The Emergency Department
- Author
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Cadigan, Greg
- Abstract
Background and Purpose: A cluster randomised controlled trial was undertaken to evaluate a theory-informed, nurse-initiated protocol-based intervention to improve multidisciplinary Triage, Treatment and Transfer of Patients with acute stroke in emergency departments (EDs): The T3 Trial. The aim of the process evaluation was to understand the extent to which intervention sites integrated the T3 clinical protocols into practice and to identify contextual factors that may have influenced uptake and adoption of the protocols. Methods: Descriptive qualitative study design using face-to-face semi-structured interviews. Purposive sampling was used to select ED clinicians from two high and two low performing intervention sites. Eligible participants were as follows: Medical Directors, Nurse Unit Mangers, bedside nurses and clinical champions. Participants were interviewed about their views on barriers and facilitators to implementation. Data were analysed thematically. Results: Twenty-five interviews were completed. Three major themes were: the dynamics of change, protocol fidelity and care trajectory. Dynamics of change represents the challenges of achieving implementation in a context of high staff turnover; Fidelity to the protocol represents the impact of organisational factors on intervention fidelity, and Care Trajectory represents the availability of resources along the patient pathway that impact on whether elements of the protocols were delivered. Implications: Implementing an intervention in the busy and complex setting of the ED can compromise the delivery of evidence-based care protocols. Factors that affect delivery including resources, staff turnover and workplace context require addressing to ensure success implementation.Australian New Zealand Clinical Trials Registry: ACTRN12614000939695.
- Published
- 2017
15. Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care.
- Author
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Cadilhac, Dominique A., Grimley, Rohan, Kilkenny, Monique F., Andrew, Nadine E., Lannin, Natasha A., Hill, Kelvin, Grabsch, Brenda, Levi, Christopher R., Thrift, Amanda G., Faux, Steven G., Wakefield, John, Cadigan, Greg, Donnan, Geoffrey A., Middleton, Sandy, and Anderson, Craig S.
- Published
- 2019
- Full Text
- View/download PDF
16. Triage, treatment and transfer of patients with stroke in emergency department trial (the T³ Trial): a cluster randomised trial protocol.
- Author
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Middleton, Sandy, Levi, Chris, Dale, Simeon, Cheung, N. Wah, McInnes, Elizabeth, Considine, Julie, D'Este, Catherine, Cadilhac, Dominique A., Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark, and Ward, Jeanette
- Subjects
CLUSTER randomized controlled trials ,THROMBOLYTIC therapy ,STROKE patients ,DEGLUTITION disorders ,STROKE prevention ,TRANSITIONAL care - Abstract
Background: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T³) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated. Methods: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T³ intervention or no additional support (control EDs). Our T³ intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented. Discussion: This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
17. Better outcomes for hospitalized patients with TIA when in stroke units
- Author
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Cadilhac, Dominique A., Kim, Joosup, Lannin, Natasha A., Levi, Christopher R., Dewey, Helen M., Hill, Kelvin, Faux, Steven, Andrew, Nadine E., Kilkenny, Monique F., Grimley, Rohan, Thrift, Amanda G., Grabsch, Brenda, Middleton, Sandy, Anderson, Craig S., Donnan, Geoffrey A., Hughes, James, Jude, Martin, Ryan, Fiona, Gill, Melissa, Herkes, Geoffrey, Wong, Andrew, Saines, Noel, Geraghty, Richard, Bambery, Pradeep, Staples, Christopher, Siller, Amanda, White, Richard, Sabet, Arman, Salud, Eva, Dunlop, Martin, Gange, Nisal, Easton, Paula, Mahaffey, Graham, Hall, Graham, De Wytt, Carolyn, Butler, Sean, Laird, Paul, Hines, Karen, Douglas, David, Admin, M, Milosevic, Suzana, Iedema, Joel, Read, Stephen, Hishon, Francis, Blacker, David, Bates, Tim, Castley, Helen, Mackay, Mark, Bladin, Christopher, Butler, Ernie, O’Brien, Peter, Crompton, Douglas, Ermel, Sharan, Pollack, Michael, Simmonds, Frances, Bernhardt, Julie, Lalor, Erin, McNeil, John, Simcocks, Mark, Lee, Andrew, Lindley, Richard, Cadigan, Greg, Hand, Peter, Evans, Andrew, Wesseldine, Andrew, and Hillier, Susan
- Published
- 2016
- Full Text
- View/download PDF
18. Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals.
- Author
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Thayabaranathan, Tharshanah, Andrew, Nadine E., Grimley, Rohan, Stroil-Salama, Enna, Grabsch, Brenda, Hill, Kelvin, Cadigan, Greg, Purvis, Tara, Middleton, Sandy, Kilkenny, Monique F., and Cadilhac, Dominique A.
- Subjects
HOSPITAL care ,MEDICAL personnel - Abstract
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
19. Additional file 1: of Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol
- Author
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Middleton, Sandy, Levi, Chris, Dale, Simeon, N. Cheung, McInnes, Elizabeth, Considine, Julie, DâEste, Catherine, Cadilhac, Dominique, Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark, and Ward, Jeanette
- Subjects
education ,technology, industry, and agriculture ,food and beverages ,humanities ,3. Good health - Abstract
SPIRIT Flow diagram of the progress through the T3 Trial: schedule of enrolment, interventions, and assessments. (DOC 41Â kb)
20. Additional file 1: of Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol
- Author
-
Middleton, Sandy, Levi, Chris, Dale, Simeon, N. Cheung, McInnes, Elizabeth, Considine, Julie, DâEste, Catherine, Cadilhac, Dominique, Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark, and Ward, Jeanette
- Subjects
education ,technology, industry, and agriculture ,food and beverages ,humanities ,3. Good health - Abstract
SPIRIT Flow diagram of the progress through the T3 Trial: schedule of enrolment, interventions, and assessments. (DOC 41Â kb)
21. Triage, treatment and transfer of patients with stroke in emergency department trial (the T3 Trial): a cluster randomised trial protocol.
- Author
-
Middleton, Sandy, Levi, Chris, Dale, Simeon, Cheung, N Wah, McInnes, Elizabeth, Considine, Julie, D'Este, Catherine, Cadilhac, Dominique A, Grimshaw, Jeremy, Gerraty, Richard, Craig, Louise, Schadewaldt, Verena, McElduff, Patrick, Fitzgerald, Mark, Quinn, Clare, Cadigan, Greg, Denisenko, Sonia, Longworth, Mark, Ward, Jeanette, and T3 Trialist Collaborators
- Subjects
TREATMENT of fever ,HYPERGLYCEMIA treatment ,TISSUE plasminogen activator ,CLUSTER analysis (Statistics) ,COMPARATIVE studies ,DEGLUTITION disorders ,HEALTH surveys ,HOSPITAL admission & discharge ,HOSPITAL emergency services ,INFORMATION retrieval ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL quality control ,MEDICAL cooperation ,MEDICAL research ,QUESTIONNAIRES ,RESEARCH ,STROKE ,MEDICAL triage ,SAMPLE size (Statistics) ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,ACQUISITION of data ,BLIND experiment ,BARTHEL Index ,THERAPEUTICS - Abstract
Background: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T3) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated.Methods: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented.Discussion: This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke.Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12614000939695 . Registered 2 September 2014. [ABSTRACT FROM AUTHOR]- Published
- 2016
22. Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia.
- Author
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Kim J, Grimley R, Kilkenny MF, Cadigan G, Johnston T, Andrew NE, Thrift AG, Lannin NA, Sundararajan V, and Cadilhac DA
- Subjects
- Humans, Male, Australia, Retrospective Studies, Hospitalization, Ischemic Attack, Transient therapy, Stroke therapy
- Abstract
Background: Stroke is a high-cost condition. Detailed patient-level assessments of the costs of care received and outcomes achieved provide useful information for organisation and optimisation of the health system., Objectives: To describe the costs of hospital care for stroke and transient ischaemic attack (TIA) and investigate factors associated with costs., Methods: Retrospective cohort study using data from the Australian Stroke Clinical Registry (AuSCR) collected between 2009 and 2013 linked to hospital administrative data and clinical costing data in Queensland. Clinical costing data include standardised assignment of costs from hospitals that contribute to the National Hospital Costing programme. Patient-level costs for each hospital admission were described according to the demographic, clinical and treatment characteristics of patients. Multivariable median regression with clustering by hospital was used to determine factors associated with greater costs., Results: Among 22 hospitals, clinical costing data were available for 3909 of 5522 patient admissions in the AuSCR (71%). Compared to those without clinical costing data, patients with clinical costing data were more often aged <65 years (30% with cost data vs 24% without cost data, p < 0.001) and male (56% with cost data vs 49% without cost data, p < 0.001). Median cost of an acute episode was $7945 (interquartile range $4176 to $14970) and the median length of stay was 5 days (interquartile range 2 to 10 days). The most expensive cost buckets were related to medical ( n = 3897, median cost $1577), nursing ( n = 3908, median cost $2478) and critical care ( n = 434, median cost $3064). Factors associated with greater total costs were a diagnosis of intracerebral haemorrhage, greater socioeconomic position, in-hospital stroke and prior history of stroke., Conclusion: Medical and nursing costs were incurred by most patients admitted with stroke or TIA, and were relatively more expensive on average than other cost buckets such as imaging and allied health., Implications: Scaling this data linkage to national data collections may provide valuable insights into activity-based funding at public hospitals. Regular report of these costs should be encouraged to optimise economic evaluations.
- Published
- 2023
- Full Text
- View/download PDF
23. Triage, treatment and transfer of patients with stroke in emergency department trial (the T 3 Trial): a cluster randomised trial protocol.
- Author
-
Middleton S, Levi C, Dale S, Cheung NW, McInnes E, Considine J, D'Este C, Cadilhac DA, Grimshaw J, Gerraty R, Craig L, Schadewaldt V, McElduff P, Fitzgerald M, Quinn C, Cadigan G, Denisenko S, Longworth M, and Ward J
- Subjects
- Adult, Aged, Cluster Analysis, Data Collection, Deglutition Disorders therapy, Double-Blind Method, Emergency Service, Hospital, Female, Fever therapy, Humans, Hyperglycemia therapy, Information Storage and Retrieval, Male, Middle Aged, New South Wales, Patient Transfer methods, Prospective Studies, Quality of Health Care, Queensland, Sample Size, Tissue Plasminogen Activator therapeutic use, Translational Research, Biomedical, Treatment Outcome, Victoria, Young Adult, Stroke nursing, Triage methods
- Abstract
Background: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T
3 ) of patients with acute stroke to improve 90-day death and dependency. Organisational and contextual factors associated with intervention uptake also will be evaluated., Methods: This prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment will be conducted in EDs of hospitals with stroke units in three Australian states and one territory. EDs will be randomised 1:1 within strata defined by state and tPA volume to receive either the T3 intervention or no additional support (control EDs). Our T3 intervention comprises an evidence-based care bundle targeting: (1) triage: routine assignment of patients with suspected stroke to Australian Triage Scale category 1 or 2; (2) treatment: screening for tPA eligibility and administration of tPA where applicable; instigation of protocols for management of fever, hyperglycaemia and swallowing; and (3) transfer: prompt admission to the stroke unit. We will use implementation science behaviour change methods informed by the Theoretical Domains Framework [1, 2] consisting of (i) workshops to determine barriers and local solutions; (ii) mixed interactive and didactic education; (iii) local clinical opinion leaders; and (iv) reminders in the form of email, telephone and site visits. Our primary outcome measure is 90 days post-admission death or dependency (modified Rankin Scale >2). Secondary outcomes are health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and quality of care outcomes, namely, monitoring and management practices for thrombolysis, fever, hyperglycaemia, swallowing and prompt transfer. Outcomes will be assessed at the patient level. A separate process evaluation will examine contextual factors to successful intervention uptake. At the time of publication, EDs have been randomised and the intervention is being implemented., Discussion: This theoretically informed intervention is aimed at addressing important gaps in care to maximise 90-day health outcomes for patients with stroke., Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12614000939695 . Registered 2 September 2014.- Published
- 2016
- Full Text
- View/download PDF
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