HOSPITAL SERVICES FOR STROKE CARE - A EUROPEAN PERSPECTIVE

Background and Purpose Stroke is a common cause of mortality and morbi dity in Europe and a major consumer of healthcare costs. However, outc omes from stroke vary significantly across Europe, raising the issue o f the extent to which the delivery of care varies across Europe. Metho ds A multicenter, multinational study collected data on hospital admis sions for stroke. These included patient baseline characteristics, cli nical status, and use of inpatient services. Results Initial results e xamined inpatient services in nine hospitals in six countries. Statist ically significant differences existed between hospitals in key proces ses of care, most notably in the areas of (1) mean length of stay (11 to 39 days) and median length of stay (8 to 21 days), (2) percentage o f admissions receiving brain imaging (30% to 98%) and neurosurgery (0% to 31%), and (3) percentage of admissions with an identified ''need'' who received physiotherapy (44% to 90%) and occupational (0% to 65%) and speech (0% to 59%) therapy. Although there were significant hospit al differences (P < .001) in the case mix of admissions in terms of le vel of consciousness, presence of incontinence, prestroke Rankin Scale score, and age, these did not explain the differences in care across sites. Conclusions There is geographic inequity across Europe in the c are a stroke patient can expect to receive. Ongoing analysis will exam ine the link between European variations in service use and outcomes, in terms of mortality, handicap, and functional ability, as a means of indicating which patterns of care are the most effective.