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Processes of early stroke care and hospital costs

Authors

  • Marie Louise Svendsen,

    Corresponding author
    1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
    2. Department of Health Technology Assessment and Health Services Research, Public Health and Quality Improvement, Aarhus N, Denmark
    • Correspondence: Marie Louise Svendsen, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.

      E-mail: mls@dce.au.dk

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  • Lars H. Ehlers,

    1. Danish Center for Health Care Improvements, Faculty of Social Science and Health Science, Aalborg University, Aalborg, Denmark
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  • Heidi H. Hundborg,

    1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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  • Annette Ingeman,

    1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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  • Søren P. Johnsen

    1. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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  • Conflicts of interest: None declared.
  • Funding: The study was funded by the Research Foundation of Health Science in The Central Denmark Region.
  • The study was presented at the 8th World Stroke Congress in Brazil, 2012.

Abstract

Background

The relationship between processes of early stroke care and hospital costs remains unclear.

Aims

We therefore examined the association in a population-based cohort study.

Methods

We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010. The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization, early catheterization, and early thromboembolism prophylaxis. Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges.

Results

The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis.

Conclusions

Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

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