{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:53:04Z","timestamp":1772239984373,"version":"3.50.1"},"reference-count":39,"publisher":"BMJ","issue":"8","funder":[{"name":"The Nancy & Vic Allen Stroke Prevention Fund"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,14]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before\u2013after observational study design.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a \u2018top-ranked\u2019 hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Primary and secondary outcome measures<\/jats:title>\n                  <jats:p>Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3\u2009months before the intervention (preintervention), 3\u2009months postintervention and at 12\u2009months (sustainability).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p&lt;0.001); discharge planning (72%vs94%, p&lt;0.001); composite outcome (73%vs89%, p&lt;0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016010","type":"journal-article","created":{"date-parts":[[2018,6,26]],"date-time":"2018-06-26T06:29:05Z","timestamp":1529994545000},"page":"e016010","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before\u2013after pilot study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-682X","authenticated-orcid":false,"given":"Dominique A","family":"Cadilhac","sequence":"first","affiliation":[{"name":"Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia"},{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine E","family":"Andrew","sequence":"additional","affiliation":[{"name":"Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enna","family":"Stroil Salama","sequence":"additional","affiliation":[{"name":"Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), University of Queensland, Brisbane, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelvin","family":"Hill","sequence":"additional","affiliation":[{"name":"Stroke Foundation, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandy","family":"Middleton","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor","family":"Horton","sequence":"additional","affiliation":[{"name":"School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Meade","sequence":"additional","affiliation":[{"name":"Acute Stroke Unit, The Townsville Hospital, Townsville, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Kuhle","sequence":"additional","affiliation":[{"name":"Redcliffe Hospital, Redcliffe, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Tasmania, Hobart, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohan","family":"Grimley","sequence":"additional","affiliation":[{"name":"Sunshine Coast Clinical School, The University of Queensland, Nambour, Australia"},{"name":"Queensland Department of Health, Brisbane, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,8,4]]},"reference":[{"key":"2025101810462035000_7.8.e016010.1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1212\/WNL.0000000000000610","article-title":"The global burden of neurologic diseases","volume":"83","author":"Chin","year":"2014","journal-title":"Neurology"},{"key":"2025101810462035000_7.8.e016010.2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.602615"},{"key":"2025101810462035000_7.8.e016010.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003368"},{"key":"2025101810462035000_7.8.e016010.4","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12325"},{"key":"2025101810462035000_7.8.e016010.5","first-page":"CD000313","article-title":"Discharge planning from hospital","volume":"1","author":"Goncalves-Bradley","year":"2016","journal-title":"The Cochrane database of systematic reviews"},{"key":"2025101810462035000_7.8.e016010.6","unstructured":"National Stroke Foundation. 2015. 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