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Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. (Riksstroke)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. (Riksstroke)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. (Risstroke)ORCID iD: 0000-0003-0394-5096
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. (Riksstroke)
2015 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 3, 806-812 p.Article 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. Vol. 46, no 3, 806-812 p.
Keyword [en]
Riksstroke, stroke, thrombolytic therapy
National Category
Neurology Cardiac and Cardiovascular Systems Neurosciences
Identifiers
URN: urn:nbn:se:umu:diva-101599DOI: 10.1161/STROKEAHA.114.007212ISI: 000350284900044PubMedID: 25657174OAI: oai:DiVA.org:umu-101599DiVA: diva2:802864
Available from: 2015-04-13 Created: 2015-04-07 Last updated: 2017-12-04Bibliographically approved

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Asplund, KjellSukhova, MariaWester, PerStegmayr, Birgitta

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