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Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study

OBJECTIVE: To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams. DESIGN: For each of four types of stroke care teams, a two-level count dat...

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Autores principales: Lugo-Palacios, David G, Gannon, Brenda, Gittins, Matthew, Vail, Andy, Bowen, Audrey, Tyson, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756417/
https://www.ncbi.nlm.nih.gov/pubmed/31542751
http://dx.doi.org/10.1136/bmjopen-2019-030426
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author Lugo-Palacios, David G
Gannon, Brenda
Gittins, Matthew
Vail, Andy
Bowen, Audrey
Tyson, Sarah
author_facet Lugo-Palacios, David G
Gannon, Brenda
Gittins, Matthew
Vail, Andy
Bowen, Audrey
Tyson, Sarah
author_sort Lugo-Palacios, David G
collection PubMed
description OBJECTIVE: To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams. DESIGN: For each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed. SETTING: This study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme. RESULTS: The main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category. CONCLUSIONS: Resource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation.
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spelling pubmed-67564172019-10-07 Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study Lugo-Palacios, David G Gannon, Brenda Gittins, Matthew Vail, Andy Bowen, Audrey Tyson, Sarah BMJ Open Health Economics OBJECTIVE: To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams. DESIGN: For each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed. SETTING: This study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme. RESULTS: The main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category. CONCLUSIONS: Resource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation. BMJ Publishing Group 2019-09-20 /pmc/articles/PMC6756417/ /pubmed/31542751 http://dx.doi.org/10.1136/bmjopen-2019-030426 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Economics
Lugo-Palacios, David G
Gannon, Brenda
Gittins, Matthew
Vail, Andy
Bowen, Audrey
Tyson, Sarah
Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title_full Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title_fullStr Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title_full_unstemmed Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title_short Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
title_sort variations in hospital resource use across stroke care teams in england, wales and northern ireland: a retrospective observational study
topic Health Economics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756417/
https://www.ncbi.nlm.nih.gov/pubmed/31542751
http://dx.doi.org/10.1136/bmjopen-2019-030426
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