Over 50,000 people suffer a stroke in Australia each year, two thirds for the first time in their lives with one third dying soon afterwards. Of those who survive, many will have varying degrees of permanent disability and other complications. The health care costs associated with stroke are one of the highest in the country. For example, stroke accounts for more than a million hospital bed days per year and an even higher number of bed and other assisted living facilities.
Patients with stroke are best treated rapidly in a coordinated program of care in order to maximise opportunities for recovery. However, many hospitals do not have the recommended organisational structure, personnel, and/or equipment to triage and treat patients with acute stroke according to current guidelines. The literature pertaining to quality in health care has highlighted the importance of focusing on ‘system failure’ rather than ‘practitioner failure’ to increase the implementation of best practice clinical guidelines. Quality of care is best approached by assessing the care setting, the processes of care undertaken, and key patient outcomes. Nevertheless, most routine national data collection systems for stroke focus solely on patient outcomes or administrative imperatives, such as length of stay and hospital re-admission rates, which have obvious limitations.
Over the last 10 years, the Australian Stroke Clinical Registry investigators have developed and validated quality indicators for stroke. These have also evolved with the development of comprehensive clinical guidelines for stroke management and programs to encourage audits of clinical practice and routine reporting of clinical indicators in some state jurisdictions. However, most clinical indictors and programs have had variable uptake and there has been no mechanism to collect these data routinely and systematically to provide results to clinicians to improve the quality of stroke care. Monitoring of trends in outcome requires comprehensive data collection to detect change. While the National Stroke Audit, conducted by the National Stroke Foundation (NSF) with selected or ’sentinel’ hospitals, provides an indication of the performance of the stroke healthcare system, ultimately it does not represent the overall stroke care of the population. Therefore, a national stroke registry (i.e. a population based data collection system) was chosen to provide a comprehensive description of Australia’s stroke care experiences and to enable monitoring and evaluation of the entire healthcare system.
The Australian Stroke Clinical Registry was developed as a web-based data collection tool for easy access nationally, for use as a quality assurance tool and with the capacity to link to other data systems in hospitals and other external systems such as the NSF audit tool.