Regional variations in stroke care in England, Wales and Northern Ireland:results from the National Sentinel Audit of stroke

Study objective: To identify the variations between regions in England, Wal es and Northern Ireland in the case-mix, organization and process of care f or stroke. Design: Retrospective audit of case notes and service organization. Setting: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regio ns in England, Wales and Northern Ireland. Patients: The 6894 consecutive stroke patients admitted between 1 January a nd 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stro ke Audit. Results: There are significant differences in stroke care between regions t hat cannot be explained by known case-mix or clinical variables. The propor tion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in diffe rent regions ranged between 21% and 33%. Institutionalization rates for tho se admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. Conclusions: There were widespread variations in specialist service provisi on for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical facto rs and therefore may represent different local health care policies and exp ectations.