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

Artikel i vetenskaplig tidskrift
Författare 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
Publicerad i BMJ Open
Volym 7
Nummer/häfte 9
ISSN 2044-6055
Publiceringsår 2017
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för fysiologi
Språk en
Länkar doi.org/10.1136/bmjopen-2016-015244
Ämnesord case-mix adjustment, health outcomes, inequalities, resource use, value-based healthcare
Ämneskategorier Hälsovetenskaper

Sammanfattning

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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