Stroke report in spotlight

A Hunter based stroke expert has labelled a taxpayer-funded report as “not worth the paper it is written on”, due to what he described asflaws in the methodology used to calculate its findings.
Nanjing Night Net

Acting director of John Hunter Hospital’s Acute Stroke Service, Conjoint Professor Chris Levi, has slammed a section of the Bureau of Health Information report published last month as “misleading”, after it said the hospital had “higher than expected” mortality rates for ischaemic stroke.

Professor Levi said the report didn’t take into account the severity of stroke, which he said was the dominant factor in determining a patient’s outcome.

“We’re receiving information from the Ministry [of Health] that is not accurate and it’s misleading the public, the media and the Minister [Brad Hazzard],” he said.

“There’s both national and international evidence to indicate it’s not best practice method –it’s really an inferior approach that runs a significant risk of error.

It’s not worth the piece of paper it’s written on, it’s a total waste of time and it’s just not credible.”

He said the report also didn’t take into account the ambulance bypass protocol, which means the region’s severe acute stroke patients go straight to John Hunter Hospital.

Professor Levi’s comments coincide with research published in theMedical Journal of Australia on May 1, which found “the models with the best fit for standardising mortality were those that included adjustment for stroke severity”.

It found hospitalperformance rankings could move dramatically –including from 21stout of 28 hospitals to sixth –when strokeseverity is taken into account.

Professor Levi said he commissioned Monash University researchers last year – in preparation for the release of the BHI report – to analyse the hospital’sstroke mortality rates with the inclusion of stroke severity.

“It demonstrates John Hunter is not an outlier at all, it’s actually an inlier and sits within the acceptable boundaries, in fact it’s pretty close to average.”

The BHI report used as its principal indicator a ratio that adjustedfor patient factors including age, sex and other illnesses.

BHI chief executive Dr Jean-Frederic Levesque said he remained“confident in the findings” and stood by the methodology.

“The BHI has investigated adjusting for stroke severity in 30-day mortality models, however, the analyses done using currently available information did not show a significant impact on results,” he said.

“There’salso mixed evidence about the impact of adjusting for severity. In addition, hospitals may vary in their ability to assess how severe a patient’s stroke is.

“BHI has conducted many analyses to identify if certain hospital results may be influenced by bypass systems and did not find different results.”

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