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Hospital comparison of stroke care in Sweden: A register-based study

Journal article
Authors I. Lekander
C. Willers
E. Ekstrand
M. Von Euler
B. Fagervall-Yttling
L. Henricson
K. Kostulas
M. Lilja
Katharina Stibrant Sunnerhagen
J. Teichert
H. Pessah-Rasmussen
Published in BMJ Open
Volume 7
Issue 9
ISSN 2044-6055
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Physiology
Language en
Keywords case-mix adjustment, health outcomes, inequalities, resource use, value-based healthcare
Subject categories Health Sciences


Background and purpose The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix). Method Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke. Results The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix. Conclusion Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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