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Article ; Online: Back to the Future: Observational Studies and Anticoagulant Selection for Nonvalvular Atrial Fibrillation.

Gattellari, Melina

2024 Volume 55, Issue 5, Page(s) 1171–1173

Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.124.046497
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Article ; Online: Different Strokes for Different Folks: Socioeconomic Disadvantage and Access to Stroke Reperfusion Therapies.

Denny, M Carter / Gattellari, Melina

Stroke

2022 Volume 53, Issue 7, Page(s) 2317–2319

MeSH term(s)	Brain Ischemia/therapy ; Humans ; Reperfusion ; Socioeconomic Factors ; Stroke/epidemiology ; Stroke/therapy ; Thrombectomy ; Treatment Outcome
Language	English
Publishing date	2022-05-17
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.122.039353
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Article ; Online: Letter by Gattellari and Worthington Regarding Article, "Deriving a Passive Surveillance Stroke Severity Indicator From Routinely Collected Administrative Data: The PaSSV Indicator".

Gattellari, Melina / Worthington, John Mark

Circulation. Cardiovascular quality and outcomes

2020 Volume 13, Issue 6, Page(s) e006613

MeSH term(s)	Databases, Factual ; Humans ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/therapy
Language	English
Publishing date	2020-05-29
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.120.006613
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Zs.A 6744: Show issues

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Article ; Online: Measuring stroke outcomes for 74 501 patients using linked administrative data: System-wide estimates and validation of 'home-time' as a surrogate measure of functional status.

Gattellari, Melina / Goumas, Chris / Jalaludin, Bin / Worthington, John

International journal of clinical practice

2020 Volume 74, Issue 6, Page(s) e13484

Abstract: Aims: Administrative data offer cost-effective, whole-of-population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke ('home-time') is a patient-centred ... ...

Abstract	Aims: Administrative data offer cost-effective, whole-of-population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke ('home-time') is a patient-centred outcome that can be objectively ascertained from administrative data. Population-based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative 'home-time' estimates and validate 'home-time' as a surrogate measure of functional status after stroke. Methods: Stroke hospitalisations from a state-wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90-day 'home-time' with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of 'home-time'. Results: Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median 'home-time' was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with 'home-time' (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased 'home-time' after ischaemic stroke and subarachnoid haemorrhage. Conclusions: These findings underscore the immediate and adverse impact of stroke. 'Home-time' measured using administrative data is a robust, replicable and valid patient-centred outcome enabling inexpensive population-based surveillance and system-wide quality assessment.
MeSH term(s)	Activities of Daily Living ; Aged ; Brain Ischemia/epidemiology ; Cerebral Hemorrhage/epidemiology ; Disability Evaluation ; Female ; Humans ; Male ; Middle Aged ; New South Wales ; Outcome Assessment, Health Care ; Recovery of Function/physiology ; Stroke/epidemiology ; Stroke Rehabilitation/standards ; Time Factors
Language	English
Publishing date	2020-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1386246-7
ISSN	1742-1241 ; 1368-5031
ISSN (online)	1742-1241
ISSN	1368-5031
DOI	10.1111/ijcp.13484
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Ua VI Zs.301: Show issues

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Article ; Online: The impact of disease severity adjustment on hospital standardised mortality ratios: Results from a service-wide analysis of ischaemic stroke admissions using linked pre-hospital, admissions and mortality data.

Gattellari, Melina / Goumas, Chris / Jalaludin, Bin / Worthington, John

PloS one

2019 Volume 14, Issue 5, Page(s) e0216325

Abstract: Background: Administrative data are used to examine variation in thirty-day mortality across health services in several jurisdictions. Hospital performance measurement may be error-prone as information about disease severity is not typically available ... ...

Abstract	Background: Administrative data are used to examine variation in thirty-day mortality across health services in several jurisdictions. Hospital performance measurement may be error-prone as information about disease severity is not typically available in routinely collected data to incorporate into case-mix adjusted analyses. Using ischaemic stroke as a case study, we tested the extent to which accounting for disease severity impacts on hospital performance assessment. Methods: We linked all recorded ischaemic stroke admissions between July, 2011 and June, 2014 to death registrations and a measure of stroke severity obtained at first point of patient contact with health services, across New South Wales, Australia's largest health service jurisdiction. Thirty-day hospital standardised mortality ratios were adjusted for either comorbidities, as is typically done, or for both comorbidities and stroke severity. The impact of stroke severity adjustment on mortality ratios was determined using 95% and 99% control limits applied to funnel plots and by calculating the change in rank order of hospital risk adjusted mortality rates. Results: The performance of the stroke severity adjusted model was superior to incorporating comorbidity burden alone (c-statistic = 0.82 versus 0.75; N = 17,700 patients, 176 hospitals). Concordance in outlier classification was 89% and 97% when applying 95% or 99% control limits to funnel plots, respectively. The sensitivity rates of outlier detection using comorbidity adjustment compared with gold-standard severity and comorbidity adjustment was 74% and 83% with 95% and 99% control limits, respectively. Corresponding positive predictive values were 74% and 91%. Hospital rank order of risk adjusted mortality rates shifted between 0 to 22 places with severity adjustment (Median = 4.0, Inter-quartile Range = 2-7). Conclusions: Rankings of mortality rates varied widely depending on whether stroke severity was taken into account. Funnel plots yielded largely concordant results irrespective of severity adjustment and may be sufficiently accurate as a screening tool for assessing hospital performance.
MeSH term(s)	Brain Ischemia/mortality ; Diagnosis-Related Groups ; Hospital Mortality ; Hospitals/standards ; Humans ; New South Wales ; Severity of Illness Index ; Stroke/mortality
Language	English
Publishing date	2019-05-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0216325
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Population-based stroke surveillance using big data: state-wide epidemiological trends in admissions and mortality in New South Wales, Australia.

Gattellari, Melina / Goumas, Chris / Jalaludin, Bin / Worthington, John M

Neurological research

2020 Volume 42, Issue 7, Page(s) 587–596

Abstract: Objectives: Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery.: Methods: We calculated admissions rates for ischaemic ... ...

Abstract	Objectives: Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery. Methods: We calculated admissions rates for ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage between 1 January 2005 and December 31 Results: Of 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval = -3.5% to -0.9%) ( Discussion: Improved prevention may have underpinned declining intracerebral haemorrhage rates while survival gains suggest that innovations in care are being successfully translated. Mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.
MeSH term(s)	Aged ; Aged, 80 and over ; Big Data ; Data Mining/methods ; Female ; Humans ; Male ; Middle Aged ; New South Wales/epidemiology ; Stroke/epidemiology
Language	English
Publishing date	2020-05-25
Publishing country	England
Document type	Journal Article
ZDB-ID	424428-x
ISSN	1743-1328 ; 0161-6412
ISSN (online)	1743-1328
ISSN	0161-6412
DOI	10.1080/01616412.2020.1766860
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Zs.A 1491: Show issues

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Article ; Online: Evaluating Stroke Code Activation Pathway in Emergency Departments study.

Ebker-White, Anja / Dinh, Michael / Paver, Ian / Bein, Kendall / Tastula, Kylie / Gattellari, Melina / Worthington, John

Emergency medicine Australasia : EMA

2022 Volume 34, Issue 6, Page(s) 976–983

Abstract: Objectives: To describe the clinical characteristics and outcomes of Code Stroke activations in an ED and determine predictors of a final diagnosis of stroke or transient ischemic attack (TIA) diagnosis.: Methods: This was a retrospective analysis of ...

Abstract	Objectives: To describe the clinical characteristics and outcomes of Code Stroke activations in an ED and determine predictors of a final diagnosis of stroke or transient ischemic attack (TIA) diagnosis. Methods: This was a retrospective analysis of Code Stroke activations through an ED over 2 years at a quaternary stroke referral centre. Stroke Registry data was used to identify cases with clinical information abstracted from electronic medical records. The primary outcome was a final diagnosis of acute stroke or TIA and the secondary outcome was access to reperfusion therapies (thrombolysis and or endovascular clot retrieval). Results: The study analysed data from 1354 Code Stroke patients in ED. Of all Code Strokes, 51% had a stroke or TIA diagnosis on discharge. Patient characteristics independently associated with increased risk of stroke were increasing age, pre-arrival notification by ambulance, elevated BP or presence of weakness or speech impairment as the initial presenting symptoms. Dizziness/vertigo/vestibular neuritis were the most common alternative diagnoses. One hundred and thirty-five patients (10%) underwent reperfusion therapy. Pre-arrival notification by ambulance was associated with higher proportion of eventual stroke/TIA diagnosis (68% vs 46%, P < 0.001) and significantly lower door to CT and door to needle times for patients undergoing thrombolysis. Conclusions: In a cohort of patients requiring Code Stroke activation in an ED, increased age, systolic blood pressure and weakness and speech impairment increased the risk of stroke. Prehospital notification was associated with lower door to needle times for patients undergoing thrombolysis.
MeSH term(s)	Humans ; Ischemic Attack, Transient/diagnosis ; Ischemic Attack, Transient/epidemiology ; Ischemic Attack, Transient/therapy ; Retrospective Studies ; Stroke/epidemiology ; Stroke/therapy ; Stroke/diagnosis ; Emergency Service, Hospital ; Ambulances ; Emergency Medical Services
Language	English
Publishing date	2022-07-18
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.14032
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Zs.A 5940: Show issues

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Article ; Online: The impact of disease severity adjustment on hospital standardised mortality ratios

Melina Gattellari / Chris Goumas / Bin Jalaludin / John Worthington

PLoS ONE, Vol 14, Iss 5, p e

Results from a service-wide analysis of ischaemic stroke admissions using linked pre-hospital, admissions and mortality data.

2019 Volume 0216325

Abstract: BACKGROUND:Administrative data are used to examine variation in thirty-day mortality across health services in several jurisdictions. Hospital performance measurement may be error-prone as information about disease severity is not typically available in ... ...

Abstract	BACKGROUND:Administrative data are used to examine variation in thirty-day mortality across health services in several jurisdictions. Hospital performance measurement may be error-prone as information about disease severity is not typically available in routinely collected data to incorporate into case-mix adjusted analyses. Using ischaemic stroke as a case study, we tested the extent to which accounting for disease severity impacts on hospital performance assessment. METHODS:We linked all recorded ischaemic stroke admissions between July, 2011 and June, 2014 to death registrations and a measure of stroke severity obtained at first point of patient contact with health services, across New South Wales, Australia's largest health service jurisdiction. Thirty-day hospital standardised mortality ratios were adjusted for either comorbidities, as is typically done, or for both comorbidities and stroke severity. The impact of stroke severity adjustment on mortality ratios was determined using 95% and 99% control limits applied to funnel plots and by calculating the change in rank order of hospital risk adjusted mortality rates. RESULTS:The performance of the stroke severity adjusted model was superior to incorporating comorbidity burden alone (c-statistic = 0.82 versus 0.75; N = 17,700 patients, 176 hospitals). Concordance in outlier classification was 89% and 97% when applying 95% or 99% control limits to funnel plots, respectively. The sensitivity rates of outlier detection using comorbidity adjustment compared with gold-standard severity and comorbidity adjustment was 74% and 83% with 95% and 99% control limits, respectively. Corresponding positive predictive values were 74% and 91%. Hospital rank order of risk adjusted mortality rates shifted between 0 to 22 places with severity adjustment (Median = 4.0, Inter-quartile Range = 2-7). CONCLUSIONS:Rankings of mortality rates varied widely depending on whether stroke severity was taken into account. Funnel plots yielded largely concordant results irrespective of severity adjustment and may be sufficiently accurate as a screening tool for assessing hospital performance.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial.

Gattellari, Melina / Hayen, Andrew / Leung, Dominic Y C / Zwar, Nicholas A / Worthington, John M

BMC family practice

2020 Volume 21, Issue 1, Page(s) 102

Abstract: Background: Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation.!## ...

Abstract	Background: Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation. Methods: We carried out a national, cluster randomised controlled trial in the Australian primary health care setting. General practitioners received an educational session, delivered via telephone by a medical peer and provided information about their patients selected either because they were not receiving anticoagulation or for whom anticoagulation was considered challenging. General practitioners were randomised to receive feedback from a medical specialist about the cases (expert decisional support) either before or after completing a post-test audit. The primary outcome was the proportion of patients reported as receiving oral anticoagulation. A secondary outcome assessed antithrombotic treatment as appropriate against guideline recommendations. Results: One hundred and seventy-nine general practitioners participated in the trial, contributing information about 590 cases. At post-test, 152 general practitioners (84.9%) completed data collection on 497 cases (84.2%). A 4.6% (Adjusted Relative Risk = 1.11, 95% CI = 0.86-1.43) difference in the post-test utilization of anticoagulation between groups was not statistically significant (p = 0.42). Sixty-one percent of patients in both groups received appropriate antithrombotic management according to evidence-based guidelines at post-test (Adjusted Relative Risk = 1.0; 95% CI = 0.85 to 1.19) (p = 0.97). Conclusions: Specialist feed-back in addition to an educational session did not increase the uptake of anticoagulation in patients with AF. Trial registration: ANZCTRN12611000076976 Retrospectively registered.
Language	English
Publishing date	2020-06-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2296
ISSN (online)	1471-2296
DOI	10.1186/s12875-020-01175-0
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Article ; Online: Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation

Melina Gattellari / Andrew Hayen / Dominic Y. C. Leung / Nicholas A. Zwar / John M. Worthington

BMC Family Practice, Vol 21, Iss 1, Pp 1-

a cluster randomised trial

2020 Volume 14

Abstract: Abstract Background Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of ... ...

Abstract	Abstract Background Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation. Methods We carried out a national, cluster randomised controlled trial in the Australian primary health care setting. General practitioners received an educational session, delivered via telephone by a medical peer and provided information about their patients selected either because they were not receiving anticoagulation or for whom anticoagulation was considered challenging. General practitioners were randomised to receive feedback from a medical specialist about the cases (expert decisional support) either before or after completing a post-test audit. The primary outcome was the proportion of patients reported as receiving oral anticoagulation. A secondary outcome assessed antithrombotic treatment as appropriate against guideline recommendations. Results One hundred and seventy-nine general practitioners participated in the trial, contributing information about 590 cases. At post-test, 152 general practitioners (84.9%) completed data collection on 497 cases (84.2%). A 4.6% (Adjusted Relative Risk = 1.11, 95% CI = 0.86–1.43) difference in the post-test utilization of anticoagulation between groups was not statistically significant (p = 0.42). Sixty-one percent of patients in both groups received appropriate antithrombotic management according to evidence-based guidelines at post-test (Adjusted Relative Risk = 1.0; 95% CI = 0.85 to 1.19) (p = 0.97). Conclusions Specialist feed-back in addition to an educational session did not increase the uptake of anticoagulation in patients with AF. Trial registration ANZCTRN12611000076976 Retrospectively registered.
Keywords	Atrial fibrillation ; Knowledge translation ; Stroke prevention ; Medicine (General) ; R5-920
Subject code	150
Language	English
Publishing date	2020-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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