Within eastern Asia, stroke is a major cause of death and disability, and the burden of stroke in this region is predicted to increase. The incidence of ischaemic and haemorrhagic stroke in eastern Asia is higher than in Europe and America, and a greater proportion of strokes are due to cerebral haemorrhage, for which the outcome is poor. Anecdotal evidence suggests that Chinese populations are associated with a higher incidence of severe intracranial carotid disease than Caucasian populations. High economic cost is frequent, as there is a great need for medical care in the initial phase after stroke as well as a need for long-term assistance in the late phase. Given these issues, advance in stroke management is strongly desirable. / Despite recent advances in acute stroke care, there is still lacking powerful and widely applicable routine drug therapies to improve the outcome after stroke. None of the neuroprotective agents has ever been found to be effective in human trials despite promising animal data. Thrombolytic therapy by administering tissue plasminogen activator (t-PA) is just eligible for a certain group of patients with hyperacute ischaemic stroke because of the very restricted therapeutic window and hampering side effect of haemorrhage. Perhaps the most significant advance in stroke management is not by pharmacotherapy, but rather concerns the process or system of care for stroke patients. / This research consists of two main parts: Part A is a qualitative case study, which, within a phenomenology framework, explores the implementation issues and managerial influence in a public hospital on the establishment of the stroke unit. Whilst most of the studies on stroke units deal with the efficiency and outcomes of stroke units, exploration of the implementation issues has not been described in the literature. This qualitative case study serves to explore the issues. / Part B is a prospective study by comparative method. Comparing stroke patients was performed in the trial by requiring the study subjects to meet the similar inclusion criteria- age, sex, premorbid functional status (Barthel index 90) and stroke score (NIHSS 3). Consequently, from April 2001 to April 2002, one hundred and eighty-eight patients from the stroke unit treated group and one hundred and seventy-seven patients from the general ward treated group were matched. The study was performed in view of the outcome of stroke unit care in a Chinese population has not been described in the literature, despite different patterns of stroke between Chinese and Caucasians. This part also explores the financial perspective of the stroke unit in a local setting, which is a part of the evaluation programme on cost effectiveness. Economic assessment has become an integral part of policy decision nowadays. Increasingly this trend is extending to medical decision making in day-to-day patient-provider interactions, and is important in the research-practice gap. The reasons for measuring the benefits and outcome include the need to inform professional practice, for example, with appraisal, revalidation and performance management. / In the implementation of the stroke unit, the study took into consideration the following focal areas: Understanding human benefits in social environment; needs assessment by the number of the previous hospitalizations of stroke patients; assessment of client functioning; practice effectiveness evaluation; supportive environment. This research has served to fill the gap in the literature by providing evaluations on a number of perspectives of a stroke unit- outcome, finance and implementation issues, which are the interrelated key issues of management. The highest priority for providers of a stroke service in a Chinese or Asian population must be to establish a stroke unit with a multidisciplinary team that delivers organized stroke care. / Thesis (PhDBusinessandManagement)--University of South Australia, 2005.
| Identifer | oai:union.ndltd.org:ADTP/267432 |
| Creators | Ko, Kwai Fu. |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | copyright under review |
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