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

• Published in: BMJ open Vol. 7; no. 9; p. e015244
• Main Authors: Lekander, Ingrid, Willers, Carl, Ekstrand, Elisabeth, von Euler, Mia, Fagervall-Yttling, Birgitta, Henricson, Lena, Kostulas, Konstantinos, Lilja, Mikael, Sunnerhagen, Katharina S, Teichert, Jörg, Pessah-Rasmussen, Hélène
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 2017; BMJ Publishing Group
• Subjects: Aged; Aged, 80 and over; Case-mix adjustment; Costs; Female; Health Economics; health outcomes; Health Sciences; Hospitals - statistics & numerical data; Humans; Hälsovetenskap; Hälsovetenskaper; inequalities; Logistic Models; Male; Medical and Health Sciences; Medical prognosis; Medicin och hälsovetenskap; Middle Aged; Mortality; Outcome Assessment (Health Care); Patients; Performance evaluation; Physiotherapy; Registries; Rehabilitation; resource use; Retrospective Studies; Sjukgymnastik; Smartphones; Socioeconomic Factors; Stroke; Stroke - mortality; Stroke - therapy; Sweden - epidemiology; Treatment Outcome; Trends; value-based healthcare; Sweden; health outcomes; case-mix adjustment; inequalities; resource use; value-based healthcare
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-015244

Background and purposeThe 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).MethodData 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.ResultsThe 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.ConclusionDifferences 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.