This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beech, R. Articles by Wolfe, C. Search for Related Content PubMed PubMed Citation Articles by Beech, R. Articles by Wolfe, C.

(Stroke. 1996;27:1958-1964.)
© 1996 American Heart Association, Inc.

Articles

Hospital Services for Stroke Care

A European Perspective

Roger Beech, PhD; Mark Ratcliffe, MSc; Kate Tilling, MSc; Charles Wolfe, MD on behalf of the participants of the European Study of Stroke Care

the Department of Public Health Medicine, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, St Thomas's Campus, London, UK.

Correspondence to Dr R. Beech, Department of Public Health Medicine, UMDS, St Thomas's Campus, London SE1 7EH, UK.

Background and Purpose Stroke is a common cause of mortality and morbidity in Europe and a major consumer of healthcare costs. However, outcomes from stroke vary significantly across Europe, raising the issue of the extent to which the delivery of care varies across Europe.

Methods A multicenter, multinational study collected data on hospital admissions for stroke. These included patient baseline characteristics, clinical status, and use of inpatient services.

Results Initial results examined inpatient services in nine hospitals in six countries. Statistically significant differences existed between hospitals in key processes 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 of 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 hospital differences (P<.001) in the case mix of admissions in terms of level 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 care a stroke patient can expect to receive. Ongoing analysis will examine 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.

Key Words: Europe • geography • hospitalization • stroke management • stroke outcome

This article has been cited by other articles:

				L. De Wit, K. Putman, E. Dejaeger, I. Baert, P. Berman, K. Bogaerts, N. Brinkmann, L. Connell, H. Feys, W. Jenni, et al. Use of Time by Stroke Patients: A Comparison of Four European Rehabilitation Centers Stroke, September 1, 2005; 36(9): 1977 - 1983. [Abstract] [Full Text] [PDF]

				C. McKevitt, C. Coshall, K. Tilling, and C. Wolfe Are There Inequalities in the Provision of Stroke Care?: Analysis of an Inner-City Stroke Register Stroke, February 1, 2005; 36(2): 315 - 320. [Abstract] [Full Text] [PDF]

				C D A Wolfe, K Tilling, A Rudd, M Giroud, and D Inzitari Variations in care and outcome in the first year after stroke: a Western and Central European perspective J. Neurol. Neurosurg. Psychiatry, December 1, 2004; 75(12): 1702 - 1706. [Abstract] [Full Text] [PDF]

				The Glasgow Augmented Physiotherapy Study (GAPS) g Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial Clinical Rehabilitation, May 1, 2004; 18(5): 529 - 537. [Abstract] [PDF]

				A. Di Carlo, M. Lamassa, M. Baldereschi, G. Pracucci, A. M. Basile, C. D.A. Wolfe, M. Giroud, A. Rudd, A. Ghetti, and D. Inzitari Sex Differences in the Clinical Presentation, Resource Use, and 3-Month Outcome of Acute Stroke in Europe: Data From a Multicenter Multinational Hospital-Based Registry Stroke, May 1, 2003; 34(5): 1114 - 1119. [Abstract] [Full Text] [PDF]

				K. Sugioka, T. Hozumi, R. R. Sciacca, Y. Miyake, I. Titova, G. Gaspard, R. L. Sacco, S. Homma, and M. R. Di Tullio Impact of Aortic Stiffness on Ischemic Stroke in Elderly Patients Stroke, August 1, 2002; 33(8): 2077 - 2081. [Abstract] [Full Text] [PDF]

				R. Grieve, J. Hutton, A. Bhalla, D. Rastenyte, D. Ryglewicz, C. Sarti, M. Lamassa, M. Giroud, R. Dundas, and C.D.A. Wolfe A Comparison of the Costs and Survival of Hospital-Admitted Stroke Patients Across Europe Stroke, July 1, 2001; 32(7): 1684 - 1691. [Abstract] [Full Text] [PDF]

				N. U. Weir, P. A. G. Sandercock, S. C. Lewis, D. F. Signorini, and C. P. Warlow Variations Between Countries in Outcome After Stroke in the International Stroke Trial (IST) Stroke, June 1, 2001; 32(6): 1370 - 1377. [Abstract] [Full Text] [PDF]

				R. Handschu, A. Garling, P. U. Heuschmann, P. L. Kolominsky-Rabas, F. Erbguth, and B. Neundorfer Acute Stroke Management in the Local General Hospital Stroke, April 1, 2001; 32(4): 866 - 870. [Abstract] [Full Text] [PDF]

				C. McKevitt, R. Dundas, and C. Wolfe Two Simple Questions to Assess Outcome After Stroke : A European Study Stroke, March 1, 2001; 32(3): 681 - 686. [Abstract] [Full Text] [PDF]

				M. Lamassa, A. Di Carlo, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, S. Spolveri, M. C. Baruffi, G. Landini, A. Ghetti, et al. Characteristics, Outcome, and Care of Stroke Associated With Atrial Fibrillation in Europe : Data From a Multicenter Multinational Hospital-Based Registry (The European Community Stroke Project) Stroke, February 1, 2001; 32(2): 392 - 398. [Abstract] [Full Text] [PDF]

				M. J. Muro, J. de Pedro-Cuesta, J. Almazan, and L. W. Holmqvist Stroke Patients in South Madrid : Function and Motor Recovery, Resource Utilization, and Family Support Stroke, June 1, 2000; 31(6): 1352 - 1359. [Abstract] [Full Text] [PDF]

				J. J. Caro, K. F. Huybrechts, and I. Duchesne Management Patterns and Costs of Acute Ischemic Stroke : An International Study Stroke, March 1, 2000; 31(3): 582 - 590. [Abstract] [Full Text] [PDF]

				J. J. Caro and K. F. Huybrechts Stroke Treatment Economic Model (STEM) : Predicting Long-Term Costs From Functional Status Stroke, December 1, 1999; 30(12): 2574 - 2579. [Abstract] [Full Text] [PDF]

				A. Di Carlo, M. Lamassa, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, C. D. A. Wolfe, K. Tilling, S. Ebrahim, and D. Inzitari Stroke in the Very Old : Clinical Presentation and Determinants of 3-Month Functional Outcome: A European Perspective Stroke, November 1, 1999; 30(11): 2313 - 2319. [Abstract] [Full Text] [PDF]

				R. Beech, A. G. Rudd, K. Tilling, and C. D. A. Wolfe Economic Consequences of Early Inpatient Discharge to Community-Based Rehabilitation for Stroke in an Inner-London Teaching Hospital Stroke, April 1, 1999; 30(4): 729 - 735. [Abstract] [Full Text] [PDF]

				C. D. A. Wolfe, K. Tilling, R. Beech, and A. G. Rudd Variations in Case Fatality and Dependency From Stroke in Western and Central Europe Stroke, February 1, 1999; 30(2): 350 - 356. [Abstract] [Full Text] [PDF]

				M. Lemesle, C. Milan, J. Faivre, T. Moreau, M. Giroud, and R. Dumas Incidence Trends of Ischemic Stroke and Transient Ischemic Attacks in a Well-Defined French Population From 1985 Through 1994 Stroke, February 1, 1999; 30(2): 371 - 377. [Abstract] [Full Text] [PDF]

				D. Inzitari, A. Di Carlo, G. Pracucci, M. Lamassa, P. Vanni, M. Romanelli, S. Spolveri, P. Adriani, I. Meucci, G. Landini, et al. Incidence and Determinants of Poststroke Dementia as Defined by an Informant Interview Method in a Hospital-Based Stroke Registry Stroke, October 1, 1998; 29(10): 2087 - 2093. [Abstract] [Full Text] [PDF]