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Title: Regional variation in acute stroke care organisation
Authors: Muñoz Venturelli, P
Robinson, Thompson
Lavados, PM
Olavarría, VV
Arima, H
Billot, L
Hackett, ML
Lim, JY
Middleton, S
Pontes-Neto, O
Peng, B
Cui, L
Song, L
Mead, G
Watkins, C
Lin, R-T
Lee, T-H
Pandian, J
de Silva, HA
Anderson, CS
HeadPoST Investigators
First Published: 18-Oct-2016
Publisher: Elsevier for World Federation of Neurology
Citation: Journal of the Neurological Sciences, 2016, 371, pp. 126-130
Abstract: BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS: 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
DOI Link: 10.1016/j.jns.2016.10.026
ISSN: 0022-510X
eISSN: 1878-5883
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2016, Elsevier B.V. Deposited with reference to the publisher’s open access archiving policy.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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