Geographic Differences in Acute Stroke Care in Catalunya: Impact of a Regional Interhospital Network
| Autor: | Carlos A. Molina, Raquel Delgado-Mederos, Manuel Quintana, Olga Maisterra, Carme Sanclemente, Marc Ribó, Marta Rubiera, Estevo Santamarina, Àngels Pedragosa, José Alvarez-Sabín |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Patient Transfer Program evaluation Hospitals Community Community Networks Health Services Accessibility Regional Health Planning Hospitals University Residence Characteristics Health care Humans Medicine Thrombolytic Therapy Healthcare Disparities Patient transfer Aged Acute stroke Aged 80 and over Neurologic Examination business.industry Equity (finance) Middle Aged medicine.disease Stroke Outcome and Process Assessment Health Care Treatment Outcome Neurology Multicenter study Spain Acute Disease Critical Pathways Regional health planning Female Neurology (clinical) Medical emergency Cardiology and Cardiovascular Medicine business Limited resources Program Evaluation |
| Zdroj: | Cerebrovascular Diseases. 26:284-288 |
| ISSN: | 1421-9786 1015-9770 |
| DOI: | 10.1159/000147457 |
| Popis: | Limited resources prevent specialized care in community hospitals (CH) challenging geographical equity. We studied the impact of a regional interhospital network based on urgent transfer from 4 CH to a referral stroke center (RSC). Methods: During 2006, all stroke patients admitted to the 5 networked hospitals (4 CH, 1 RSC) were studied: clinical pathways and stroke interventions were recorded. Physicians at CH decided emergent transfer under their clinical judgment. Quality therapeutic measures where defined: urgent expert neurological evaluation, stroke unit admission and thrombolytic treatment. For patients receiving tissue plasminogen activator, demographic and outcome data were recorded: clinical improvement (decrease ≧4 National Institute of Health Stroke Scale points at discharge), total recovery (3-month modified Rankin Scale score ≧1). Results: From a total of 1,925 acute stroke patients, 1,587 were admitted to the RSC (1,396 primarily). Of 529 primarily admitted to CH, 191 (36.1%) were emergently transferred. Patients primarily admitted to the RSC were more frequently evaluated by a neurologist (100 vs. 34%; p < 0.001) and admitted to a stroke unit (22.7 vs. 11.7%; p < 0.001). However, the rate of thrombolytic treatment was similar (4.4 vs. 5.1%; p = 0.491). After initial assessment at the RSC, 92 (48.2%) transfers were considered unnecessary. Transferred patients accounted for 27/88 (30.7%) thrombolyses performed in the RSC. Baseline characteristics were similar, except a longer time to treatment (164 vs. 211 min; p = 0.004) and more frequent early ischemia CT signs among transferred patients (23 vs. 53%; p = 0.037). Clinical improvement (62 vs. 50%; p = 0.273) and symptomatic hemorrhagic transformation (6.8 vs. 3.8%; p = 0.596) were similar. However, among transferred patients, the degree of total recovery was lower (44 vs. 22%; p = 0.05). Conclusion: An interhospital network based on transfers to an RSC does not warrant geographical equity: equal access to best therapeutic interventions is only partially achieved at the expense of a high proportion of unnecessary transfers. |
| Databáze: | OpenAIRE |
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