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首页> 美国卫生研究院文献>British Medical Journal >Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis
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Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis

机译：在英国大都市地区集中急性中风服务对死亡率和住院时间的影响：差异分析

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>Objective To investigate whether centralisation of acute stroke services in two metropolitan areas of England was associated with changes in mortality and length of hospital stay.>Design Analysis of difference-in-differences between regions with patient level data from the hospital episode statistics database linked to mortality data supplied by the Office for National Statistics.>Setting Acute stroke services in Greater Manchester and London, England.>Participants 258 915 patients with stroke living in urban areas and admitted to hospital in January 2008 to March 2012.>Interventions “Hub and spoke” model for acute stroke care. In London hyperacute care was provided to all patients with stroke. In Greater Manchester hyperacute care was provided to patients presenting within four hours of developing symptoms of stroke.>Main outcome measures Mortality from any cause and at any place at 3, 30, and 90 days after hospital admission; length of hospital stay.>Results In London there was a significant decline in risk adjusted mortality at 3, 30, and 90 days after admission. At 90 days the absolute reduction was −1.1% (95% confidence interval −2.1 to −0.1; relative reduction 5%), indicating 168 fewer deaths (95% confidence interval 19 to 316) during the 21 month period after reconfiguration in London. In both areas there was a significant decline in risk adjusted length of hospital stay: −2.0 days in Greater Manchester (95% confidence interval −2.8 to −1.2; 9%) and −1.4 days in London (−2.3 to −0.5; 7%). Reductions in mortality and length of hospital stay were largely seen among patients with ischaemic stroke.>Conclusions A centralised model of acute stroke care, in which hyperacute care is provided to all patients with stroke across an entire metropolitan area, can reduce mortality and length of hospital stay.
机译：>目的调查英格兰两个大都市地区急性卒中服务的集中化是否与死亡率和住院时间的变化有关。>设计分析之间的差异与来自医院发作统计数据库的患者水平数据相关联的区域，这些数据与国家统计局提供的死亡率数据相关。>设置大曼彻斯特和英格兰伦敦的急性中风服务。>参与者 2008年1月至2012年3月，居住在市区并入院的258-915例中风患者。>干预“中枢和说话”模式用于急性中风护理。在伦敦，为所有中风患者提供了超急性护理。在大曼彻斯特，中风症状出现后四小时内出现的患者将获得超急性护理。>主要结果指标：住院后3天，30天和90天任何地方的死亡率。 >结果在伦敦，入院后3天，30天和90天，风险调整后的死亡率显着下降。在90天时，绝对减少量为-1.1％（95％置信区间-2.1至-0.1；相对减少5％），表明在伦敦重新配置后的21个月内，死亡人数减少了168位（95％置信区间19至316）。在这两个地区，经过风险调整的住院时间均显着下降：大曼彻斯特为-2.0天（95％置信区间为-2.8至-1.2； 9％），伦敦为-1.4天（-2.3至-0.5； 7） ％）。在缺血性中风患者中，死亡率和住院时间的减少大部分可见。>结论：急性中风护理的集中化模型，其中为整个大都市地区的所有中风患者提供超急性护理，可以降低死亡率和住院时间。

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