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Sukhova, Maria
Publications (2 of 2) Show all publications
Asplund, K., Sukhova, M., Wester, P. & Stegmayr, B. (2015). Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals. Stroke, 46(3), 806-812
Open this publication in new window or tab >>Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals
2015 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 3, p. 806-812Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance. Methods: Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals. Results: The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital. Conclusions: In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Riksstroke, stroke, thrombolytic therapy
National Category
Neurology Cardiac and Cardiovascular Systems Neurosciences
urn:nbn:se:umu:diva-101599 (URN)10.1161/STROKEAHA.114.007212 (DOI)000350284900044 ()25657174 (PubMedID)
Available from: 2015-04-13 Created: 2015-04-07 Last updated: 2018-06-07Bibliographically approved
Glader, E.-L., Edlund, H., Sukhova, M., Asplund, K., Norrving, B. & Eriksson, M. (2013). Reduced inequality in access to stroke unit care over time: a 15-year follow-up of socioeconomic disparities in Sweden. Cerebrovascular Diseases, 36(5-6), 407-411
Open this publication in new window or tab >>Reduced inequality in access to stroke unit care over time: a 15-year follow-up of socioeconomic disparities in Sweden
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2013 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 36, no 5-6, p. 407-411Article in journal (Refereed) Published
Abstract [en]

Background: Despite the compelling scientific evidence on the superiority of stroke unit care, far from all acute stroke patients have access to stroke unit care. In congruence with what has been observed when other new methods are introduced in health care, we hypothesized that there has been an inequality in the buildup phase of stroke units but that the gradients between patient groups have decreased as the total capacity of stroke unit care has increased. The purpose of this study was to explore if patients in a national sample who were socioeconomically disadvantaged (low education or low income) had reduced access to stroke unit care and if differences varied over time.

Methods: All patients 18-74 years of age registered between 1995 and 2009 in Riks-Stroke, the Swedish stroke register, were included. The Stroke Unit Trialists' definition of a stroke unit has been adopted by Riks-Stroke and hospitals participating in the registry. Basic patient characteristics, stroke risk factors, process and outcome variables are recorded in Riks-Stroke. Socioeconomic data were accessed from Statistics Sweden. Multiple logistic regression analyses were used to calculate odds ratios (ORs) for stroke unit care between prespecified patient subgroups.

Results: A total of 319,240 stroke patients were included in Riks-Stroke during the years 1995-2009, and 124,173 were aged between 18 and 74 years; they were included in the final analyses. After adjustment for confounders in a multiple regression model, women were treated in stroke units slightly less often [OR 0.97, 95% confidence interval (CI) 0.95-0.99]. There were no statistically significant associations between stroke unit care and age or between stroke unit care and cohabiting or living alone. The highest level of education predicted access to stroke unit care (secondary vs. primary school: OR 1.04, 95% CI 1.01-1.07; university vs. primary school: OR 1.06, 95% CI 1.02-1.10). Differences according to level of education diminished over time (p = 0.001). Income was not independently associated with stroke unit care, and over time the proportion of patients treated in stroke units increased at a similar rate in all income groups (p = 0.12).

Conclusions: Even in a country with modest socioeconomic differences in the general population and public financing of all acute hospital care, socioeconomic inequalities in access to stroke unit care were evident during the early years, but they diminished as the total capacity for stroke unit care increased.

© 2013 S. Karger AG, Basel.

Place, publisher, year, edition, pages
S. Karger, 2013
Stroke; Stroke unit; Socioeconomic factor; riks-stroke; register
National Category
Neurology Cardiac and Cardiovascular Systems
urn:nbn:se:umu:diva-83388 (URN)10.1159/000355497 (DOI)000330857000012 ()24247019 (PubMedID)
Available from: 2013-11-22 Created: 2013-11-22 Last updated: 2018-06-08Bibliographically approved

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