Nadine Andrew - Academia.edu (original) (raw)

Papers by Nadine Andrew

Research paper thumbnail of Treatment with Multiple Therapeutic Classes of Medication is Associated with Survival after Stroke

Neuroepidemiology

Introduction: Treatment with several therapeutic classes of medication is recommended for seconda... more Introduction: Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analysed the associations between the number of classes of prevention medications supplied within 90 days post-discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. Patients and methods: Retrospective cohort study of adults with first-ever IS/TIA (2010-2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e. blood pressure-lowering, antithrombotic or lipid-lowering agents, supplied to patients within 90 days post-discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days post-hospital discharge was used to separate exposure and o...

Research paper thumbnail of Greater Adherence to Secondary Prevention Medications Improves Survival After Stroke or Transient Ischemic Attack: A Linked Registry Study

Stroke

Background and Purpose: Although a target of 80% medication adherence is commonly cited, it is un... more Background and Purpose: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. Methods: Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010–June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, ...

Research paper thumbnail of Exploring patterns of personal alarm system use and impacts on outcomes

Australasian Journal on Ageing

Research paper thumbnail of What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis

Internal and Emergency Medicine

Research paper thumbnail of Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE)

International Journal of Population Data Science

IntroductionThe growing burden of chronic diseases means some governments have been providing fin... more IntroductionThe growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AimTo outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. MethodsPerson-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to ...

Research paper thumbnail of Risk factors for the development of chest infections in acute stroke: a systematic review

Topics in Stroke Rehabilitation

Research paper thumbnail of Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care

Research paper thumbnail of Promising Use of Big Data to Increase the Efficiency and Comprehensiveness of Stroke Outcomes Research

Research paper thumbnail of Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry

International Journal of Stroke

Introduction Chest infections following acute stroke contribute to increased morbidity and mortal... more Introduction Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Methods Patient-level data from the Australian Stroke Clinical Registry (2010–13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Results Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% deve...

Research paper thumbnail of Maximising data value and avoiding data waste: a validation study in stroke research

Medical Journal of Australia

Research paper thumbnail of Correction to: Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Research paper thumbnail of Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Research paper thumbnail of Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data

Research paper thumbnail of Describing hospital utilisation and associated factors following stroke using linked clinical registry and hospital administrative data

International Journal of Population Data Science

IntroductionSurvivors of stroke have complex needs from ongoing disabilities and have increased r... more IntroductionSurvivors of stroke have complex needs from ongoing disabilities and have increased risk of cardiovascular diseases. The societal costs are therefore substantial. Person-level longitudinal data on the longer-term hospital utilizations of patients with stroke in Australia, and the factors that may influence usage in this setting, are rarely reported. Objectives and ApproachWe used person-level linkages between the Australian Stroke Clinical Registry (AuSCR: 2009-2013) and hospital admission and Emergency Department (ED) data from four states to examine determinants of hospital utilisation following stroke. The index event was the first event recorded in AuSCR. The rate of hospital contacts/person/year was calculated from contacts 30-365 days post-discharge. Disability was determined from responses to EQ-5D-3L data collected at 90-180 days post-stroke. Comorbidities were identified using ICD-10 discharge diagnosis codes (5 year look back including the index event). Negativ...

Research paper thumbnail of High quality linked data for stroke obtained using non-government clinical registry and routinely collected hospital and death data

International Journal of Population Data Science

IntroductionRecent advances in data linkage infrastructure in Australia mean that data can be lin... more IntroductionRecent advances in data linkage infrastructure in Australia mean that data can be linked based on various identifiers across datasets. In a first for Australia, we tested the feasibility of linking data between a clinical quality disease registry with Australian and state government health data across multiple jurisdictions. Objectives and ApproachTo determine whether high quality linked data for stroke can be obtained using a non-government managed registry (Australian Stroke Clinical Registry, AuSCR), national death registry data (Australian government), and hospital admission and emergency presentation data (state governments) to assess the accuracy of consistent variables across the different datasets. We used a cohort design with probabilistic data linkage to merge patient-level records. Descriptive statistics presented for matching concordance and Cohen’s kappa for concordance across demographic variables. The sensitivity and specificity of in-hospital deaths colle...

Research paper thumbnail of Using linked data to evaluate enhanced primary care policies for chronic diseases using stroke as a case study

International Journal of Population Data Science

IntroductionThe global burden of chronic diseases is large and increasing. In response, governmen... more IntroductionThe global burden of chronic diseases is large and increasing. In response, governments are investing substantial funds in innovative models of primary care, characterised by multidisciplinary care and self-management support for people with chronic conditions. Currently, large scale population-based evaluations of the effectiveness of these policies are lacking. Objectives and ApproachWe aim to evaluate the effectiveness and cost-effectiveness of enhanced primary care policies for chronic diseases funded through Medicare Australia using stroke as a case study. Person-level linkages from the following will be used: Australian Stroke Clinical Registry (AuSCR) to define the cohort; Australian government-held Medicare claims data to identify receipt or not of enhanced primary care items; state government-held hospital data to define outcomes; and Australian government-held pharmaceutical and aged care claims data to define covariates. In Australia, unique identifiers are no...

Research paper thumbnail of The Quality of Discharge Care Planning in Acute Stroke Care: Influencing Factors and Association with Postdischarge Outcomes

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 30, 2017

Comprehensive discharge planning is important for successful transitions from hospital to home af... more Comprehensive discharge planning is important for successful transitions from hospital to home after stroke. The aim of this study was to describe the quality of discharge planning received by patients discharged home from acute care, identify factors associated with a positive discharge experience, and assess the influence of discharge quality on outcomes. Patients discharged to the community and registered in the Australian Stroke Clinical Registry in 2014 were invited to participate. Patient-perceived discharge quality was evaluated using the Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services questionnaire (recall at 3-9 months). Factors associated with higher discharge quality scores were identified and associations between quality scores of more than 80% and outcomes were investigated using multivariable, multilevel regression analyses. There were 200 of 434 eligible regist...

Research paper thumbnail of Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia

BMC Health Services Research

Research paper thumbnail of The potential health and economic impact of improving stroke care standards for Australia

International Journal of Stroke

Background Evidence of the burden of suboptimal stroke care should expedite quality improvement. ... more Background Evidence of the burden of suboptimal stroke care should expedite quality improvement. We aimed to estimate the health and economic impact of improving acute stroke management to best practice standards using Australia as a case study. Methods Hospital performance in Australia was estimated using data from the National Stroke Audit of Acute Services 2013. The percentage of patients provided evidence-based therapies in all hospitals was compared to that achieved in the aggregate of top performing benchmark hospitals (that included between them, a minimum contribution of 15% of all cases audited). The number of additional patients who would receive therapies if this performance gap was rectified was applied to a standardized economic simulation model that comprised stroke rates and resource-use estimates from the North East Melbourne Stroke Incidence Study applied to the 2013 Australian population. Results In 2013, 41,398 patients were estimated to have been hospitalized wit...

Research paper thumbnail of Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

BMJ open, Jan 4, 2017

Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective wa... more 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-after observational study design. 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 'top-ranked' 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. Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. Three discharge processes collec...

Research paper thumbnail of Treatment with Multiple Therapeutic Classes of Medication is Associated with Survival after Stroke

Neuroepidemiology

Introduction: Treatment with several therapeutic classes of medication is recommended for seconda... more Introduction: Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analysed the associations between the number of classes of prevention medications supplied within 90 days post-discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. Patients and methods: Retrospective cohort study of adults with first-ever IS/TIA (2010-2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e. blood pressure-lowering, antithrombotic or lipid-lowering agents, supplied to patients within 90 days post-discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days post-hospital discharge was used to separate exposure and o...

Research paper thumbnail of Greater Adherence to Secondary Prevention Medications Improves Survival After Stroke or Transient Ischemic Attack: A Linked Registry Study

Stroke

Background and Purpose: Although a target of 80% medication adherence is commonly cited, it is un... more Background and Purpose: Although a target of 80% medication adherence is commonly cited, it is unclear whether greater adherence improves survival after stroke or transient ischemic attack (TIA). We investigated associations between medication adherence during the first year postdischarge, and mortality up to 3 years, to provide evidence-based targets for medication adherence. Methods: Retrospective cohort study of 1-year survivors of first-ever stroke or TIA, aged ≥18 years, from the Australian Stroke Clinical Registry (July 2010–June 2014) linked with nationwide prescription refill and mortality data (until August 2017). Adherence to antihypertensive agents, statins, and nonaspirin antithrombotic medications was based on the proportion of days covered from discharge until 1 year. Cox regression with restricted cubic splines was used to investigate nonlinear relationships between medication adherence and all-cause mortality (to 3 years postdischarge). Models were adjusted for age, ...

Research paper thumbnail of Exploring patterns of personal alarm system use and impacts on outcomes

Australasian Journal on Ageing

Research paper thumbnail of What is the prevalence of frequent attendance to emergency departments and what is the impact on emergency department utilisation? A systematic review and meta-analysis

Internal and Emergency Medicine

Research paper thumbnail of Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE)

International Journal of Population Data Science

IntroductionThe growing burden of chronic diseases means some governments have been providing fin... more IntroductionThe growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AimTo outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. MethodsPerson-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to ...

Research paper thumbnail of Risk factors for the development of chest infections in acute stroke: a systematic review

Topics in Stroke Rehabilitation

Research paper thumbnail of Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care

Research paper thumbnail of Promising Use of Big Data to Increase the Efficiency and Comprehensiveness of Stroke Outcomes Research

Research paper thumbnail of Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry

International Journal of Stroke

Introduction Chest infections following acute stroke contribute to increased morbidity and mortal... more Introduction Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Methods Patient-level data from the Australian Stroke Clinical Registry (2010–13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Results Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% deve...

Research paper thumbnail of Maximising data value and avoiding data waste: a validation study in stroke research

Medical Journal of Australia

Research paper thumbnail of Correction to: Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Research paper thumbnail of Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study

Research paper thumbnail of Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data

Research paper thumbnail of Describing hospital utilisation and associated factors following stroke using linked clinical registry and hospital administrative data

International Journal of Population Data Science

IntroductionSurvivors of stroke have complex needs from ongoing disabilities and have increased r... more IntroductionSurvivors of stroke have complex needs from ongoing disabilities and have increased risk of cardiovascular diseases. The societal costs are therefore substantial. Person-level longitudinal data on the longer-term hospital utilizations of patients with stroke in Australia, and the factors that may influence usage in this setting, are rarely reported. Objectives and ApproachWe used person-level linkages between the Australian Stroke Clinical Registry (AuSCR: 2009-2013) and hospital admission and Emergency Department (ED) data from four states to examine determinants of hospital utilisation following stroke. The index event was the first event recorded in AuSCR. The rate of hospital contacts/person/year was calculated from contacts 30-365 days post-discharge. Disability was determined from responses to EQ-5D-3L data collected at 90-180 days post-stroke. Comorbidities were identified using ICD-10 discharge diagnosis codes (5 year look back including the index event). Negativ...

Research paper thumbnail of High quality linked data for stroke obtained using non-government clinical registry and routinely collected hospital and death data

International Journal of Population Data Science

IntroductionRecent advances in data linkage infrastructure in Australia mean that data can be lin... more IntroductionRecent advances in data linkage infrastructure in Australia mean that data can be linked based on various identifiers across datasets. In a first for Australia, we tested the feasibility of linking data between a clinical quality disease registry with Australian and state government health data across multiple jurisdictions. Objectives and ApproachTo determine whether high quality linked data for stroke can be obtained using a non-government managed registry (Australian Stroke Clinical Registry, AuSCR), national death registry data (Australian government), and hospital admission and emergency presentation data (state governments) to assess the accuracy of consistent variables across the different datasets. We used a cohort design with probabilistic data linkage to merge patient-level records. Descriptive statistics presented for matching concordance and Cohen’s kappa for concordance across demographic variables. The sensitivity and specificity of in-hospital deaths colle...

Research paper thumbnail of Using linked data to evaluate enhanced primary care policies for chronic diseases using stroke as a case study

International Journal of Population Data Science

IntroductionThe global burden of chronic diseases is large and increasing. In response, governmen... more IntroductionThe global burden of chronic diseases is large and increasing. In response, governments are investing substantial funds in innovative models of primary care, characterised by multidisciplinary care and self-management support for people with chronic conditions. Currently, large scale population-based evaluations of the effectiveness of these policies are lacking. Objectives and ApproachWe aim to evaluate the effectiveness and cost-effectiveness of enhanced primary care policies for chronic diseases funded through Medicare Australia using stroke as a case study. Person-level linkages from the following will be used: Australian Stroke Clinical Registry (AuSCR) to define the cohort; Australian government-held Medicare claims data to identify receipt or not of enhanced primary care items; state government-held hospital data to define outcomes; and Australian government-held pharmaceutical and aged care claims data to define covariates. In Australia, unique identifiers are no...

Research paper thumbnail of The Quality of Discharge Care Planning in Acute Stroke Care: Influencing Factors and Association with Postdischarge Outcomes

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, Jan 30, 2017

Comprehensive discharge planning is important for successful transitions from hospital to home af... more Comprehensive discharge planning is important for successful transitions from hospital to home after stroke. The aim of this study was to describe the quality of discharge planning received by patients discharged home from acute care, identify factors associated with a positive discharge experience, and assess the influence of discharge quality on outcomes. Patients discharged to the community and registered in the Australian Stroke Clinical Registry in 2014 were invited to participate. Patient-perceived discharge quality was evaluated using the Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services questionnaire (recall at 3-9 months). Factors associated with higher discharge quality scores were identified and associations between quality scores of more than 80% and outcomes were investigated using multivariable, multilevel regression analyses. There were 200 of 434 eligible regist...

Research paper thumbnail of Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia

BMC Health Services Research

Research paper thumbnail of The potential health and economic impact of improving stroke care standards for Australia

International Journal of Stroke

Background Evidence of the burden of suboptimal stroke care should expedite quality improvement. ... more Background Evidence of the burden of suboptimal stroke care should expedite quality improvement. We aimed to estimate the health and economic impact of improving acute stroke management to best practice standards using Australia as a case study. Methods Hospital performance in Australia was estimated using data from the National Stroke Audit of Acute Services 2013. The percentage of patients provided evidence-based therapies in all hospitals was compared to that achieved in the aggregate of top performing benchmark hospitals (that included between them, a minimum contribution of 15% of all cases audited). The number of additional patients who would receive therapies if this performance gap was rectified was applied to a standardized economic simulation model that comprised stroke rates and resource-use estimates from the North East Melbourne Stroke Incidence Study applied to the 2013 Australian population. Results In 2013, 41,398 patients were estimated to have been hospitalized wit...

Research paper thumbnail of Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

BMJ open, Jan 4, 2017

Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective wa... more 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-after observational study design. 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 'top-ranked' 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. Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. Three discharge processes collec...