Trends and Regional Variation in Hospital Mortality, Length of Stay and Cost in Hospital of Ischemic Stroke Patients in Alberta Accompanying the Provincial Reorganization of Stroke Care

Autor: Scott Klarenbach, Thanh Nguyen, Jane E. Ruseski, D. Friesen, Ruolz Ariste, Philip Jacobs, Unto Häkkinen, Y. Zheng, Arto Ohinmaa, Padma Kaul, Thomas Jeerakathil
Rok vydání: 2016
Předmět:
Male
Pediatrics
Time Factors
Cost-Benefit Analysis
030204 cardiovascular system & hematology
Logistic regression
Alberta
Brain Ischemia
0302 clinical medicine
Patient Admission
Risk Factors
Acute care
030212 general & internal medicine
Hospital Mortality
Hospital Costs
Stroke
First episode
Aged
80 and over
Mortality rate
Rehabilitation
Middle Aged
Quality Improvement
Treatment Outcome
Regional variation
Female
Cardiology and Cardiovascular Medicine
Adult
medicine.medical_specialty
Adolescent
03 medical and health sciences
Young Adult
Cost Savings
medicine
Humans
Healthcare Disparities
Aged
Quality Indicators
Health Care
In hospital mortality
business.industry
Length of Stay
medicine.disease
Logistic Models
Ischemic stroke
Surgery
Neurology (clinical)
business
Delivery of Health Care
Demography
Program Evaluation
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 25(12)
ISSN: 1532-8511
Popis: Objectives This study aimed to evaluate the trends and regional variation of stroke hospital care in 30-day in-hospital mortality, hospital length of stay (LOS), and 1-year total hospitalization cost after implementation of the Alberta Provincial Stroke Strategy. Methods New ischemic stroke patients (N = 7632) admitted to Alberta acute care hospitals between 2006 and 2011 were followed for 1 year. We analyzed in-hospital mortality with logistic regression, LOS with negative binomial regression, and the hospital costs with generalized gamma model (log link). The risk-adjusted results were compared over years and between zones using observed/expected results. Results The risk-adjusted mortality rates decreased from 12.6% in 2006/2007 to 9.9% in 2010/2011. The regional variations in mortality decreased from 8.3% units in 2008/2009 to 5.6 in 2010/2011. The LOS of the first episode dropped significantly in 2010/2011 after a 4-year slight increase. The regional variation in LOS was 15.5 days in 2006/2007 and decreased to 10.9 days in 2010/2011. The 1-year hospitalization cost increased initially, and then kept on declining during the last 3 years. The South and Calgary zones had the lowest costs over the study period. However, this gap was diminishing. Conclusions After implementation of the Alberta Provincial Stroke Strategy, both mortality and hospital costs demonstrated a decreasing trend during the later years of study. The LOS increased slightly during the first 4 years but had a significant drop at the last year. In general, the regional variations in all 3 indicators had a diminishing trend.
Databáze: OpenAIRE
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