{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:32:11Z","timestamp":1786555931044,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to \u22648 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              There were 17\u2009502 patients from the intervention sites (median age, 74 years; 46% women) and 20\u2009484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%\u201324%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%\u201320%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%\u201317%). The national score (4 indicators) improved by 17% (95% CI, 13%\u201320%) versus 0% change in other Australian hospitals (95% CI, \u22120.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.118.023075","type":"journal-article","created":{"date-parts":[[2019,5,14]],"date-time":"2019-05-14T09:00:30Z","timestamp":1557824430000},"page":"1525-1530","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care"],"prefix":"10.1161","volume":"50","author":[{"given":"Dominique A.","family":"Cadilhac","sequence":"first","affiliation":[{"name":"From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)"},{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Grimley","sequence":"additional","affiliation":[{"name":"From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)"},{"name":"Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia (R.G.)"},{"name":"Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique F.","family":"Kilkenny","sequence":"additional","affiliation":[{"name":"From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)"},{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine E.","family":"Andrew","sequence":"additional","affiliation":[{"name":"From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)"},{"name":"Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia (N.E.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha A.","family":"Lannin","sequence":"additional","affiliation":[{"name":"College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.)"},{"name":"Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia (N.A.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Hill","sequence":"additional","affiliation":[{"name":"Clinical Services, Stroke Foundation, Melbourne, Victoria, Australia (K.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Grabsch","sequence":"additional","affiliation":[{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher R.","family":"Levi","sequence":"additional","affiliation":[{"name":"University of New South Wales, Sydney, Australia (C.R.L., S.G.F.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda G.","family":"Thrift","sequence":"additional","affiliation":[{"name":"From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Faux","sequence":"additional","affiliation":[{"name":"University of New South Wales, Sydney, Australia (C.R.L., S.G.F.)"},{"name":"Department of Rehabilitation Medicine, St. Vincent\u2019s Health Australia (Sydney), New South Wales (S.G.F.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wakefield","sequence":"additional","affiliation":[{"name":"Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Cadigan","sequence":"additional","affiliation":[{"name":"Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey A.","family":"Donnan","sequence":"additional","affiliation":[{"name":"Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandy","family":"Middleton","sequence":"additional","affiliation":[{"name":"Nursing Research Institute, St. Vincent\u2019s Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia (S.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.)"},{"name":"The George Institute China at Peking University Health Science Center, Beijing, PR China (C.S.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Stroke123 Investigators and AuSCR 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