Nadine Andrew (Australia)
Monash University
Peninsula Clinical School, Central Clinical School
A/Prof Andrew is an epidemiologist and health service researcher. She is a named investigator on a number of data linkage projects predominantly in the area of stroke and ageing. She is Chief Investigator on the PRECISE project (GNT:1141848) involving linkages between a national clinical registry (N~30,000 registrants) and a range of state and commonwealth held administrative datasets. These data are being used to evaluate the use of incentivised models of primary and allied health care in the long-term management of stroke and associated impacts on outcomes. She is also leading a number of projects aimed at improving systems for the sharing of critical data between community and hospital and integration of data between systems to improve patient care. She has presented at a number of national and international conferences on the topic of stroke data linkage, chairs the Monash HELIX data linkage committee and is the Research Data Lead for the National Centre for Healthy Ageing.

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INCENTIVISING PRIMARY CARE PRACTITIONERS TO PROVIDE COMPREHENSIVE CHRONIC DISEASE MANAGEMENT IMPROVES SURVIVAL FOLLOWING STROKE: A TARGET TRIAL APPROACH USING LINKED REGISTRY DATA.

Session Name
0650 - Heart and Brain / Health Services Research (ID 52)
Session Type
Free Communication Session
Date
29.10.2021, Friday
Session Time
08:00 - 09:30
Room
FREE COMMUNICATIONS A
Presenter
Lecture Time
08:00 - 08:10

Abstract

Background and Aims

In response to the growing burden of chronic disease, governments are investing substantially in innovative models of primary care, involving structured self-management support. Currently, large scale population-based evaluations of these policies are lacking. We aim to compare differences in survival following stroke or transient ischaemic attack, based on receipt or non-receipt of incentivised primary care management.

Methods

A target trial approach, with the study-design emulating a randomised controlled trial within a linked-data cohort, was used. Person-level linkages included data from: the Australian Stroke Clinical Registry (January 2012-June 2015) to define the cohort; Australian Medicare claims to identify relevant primary care items in the 6-18 months post-stroke (exposure period); government-held hospital, pharmaceutical and aged care datasets to define covariates; and National Death Registry to define outcomes during the 19-30 months post-stroke (outcome period). A landmark approach including those alive at the start of the outcome period was used. Multivariable survival analysis, adjusted using propensity score methods (PSM) was applied.

Results

Among 9,337 included AuSCR registrants (42% female, median age 70 years, 28% TIA), 45% received incentivised care during the exposure period and 95% were linked across all datasets. Following PSM, excellent balance was achieved between groups across 35 variables. Receipt compared to non-receipt of incentivised primary care was associated with a 28% reduced hazard of death (adjusted Hazard Ratio: 0.70, 95% CI 0.57, 0.87, p<0.001).

Conclusions

We provide an evaluation of the effectiveness of incentivised primary care within “real world” healthcare provision. Further work is underway to examine causal mechanisms.

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