Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals?

The quality of hospital care for stroke varies, particularly in rural areas. In 2007, funding to improve stroke care became available as part of the Rural Stroke Project (RSP) in New South Wales (Australia). The RSP included the employment of clinical coordinators to establish stroke units or pathways and protocols, and more clinical staff. We aimed to describe the effectiveness of RSP in improving stroke care and patient outcomes. Methods-A historical control cohort design was used. Clinical practice and outcomes at 8 hospitals were compared using 2 medical record reviews of 100 consecutive ischemic or intracerebral hemorrhage patients =12 months before RSP and 3 to 6 months after RSP was implemented. Descriptive statistics and multivariable analyses of patient outcomes are presented. Results-Sample: pre-RSP n=750 mean age 74 (SD, 13) years women 50 and post-RSP n=730 mean age 74 (SD, 13)years women 46 . Many improvements in stroke care were found after RSP: Access to stroke units (pre 0 post 58 ,P