Effects of centralizing acute stroke services: A prospective cohort study

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Effects of centralizing acute stroke services: A prospective cohort study. / Hastrup, Sidsel; Johnsen, Søren Paaske; Terkelsen, Thorkild; Hundborg, Heidi Holmager; von Weitzel-Mudersbach, Paul; Simonsen, Claus Ziegler; Hjort, Niels; Møller, Anette Torvin; Harbo, Thomas; Poulsen, Marika S; Ruiz de Morales Ayudarte, Noella; Damgaard, Dorte Winther; Andersen, Grethe.

In: Neurology, Vol. 91, No. 3, 17.07.2018, p. e235-e248.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Hastrup, S, Johnsen, SP, Terkelsen, T, Hundborg, HH, von Weitzel-Mudersbach, P, Simonsen, CZ, Hjort, N, Møller, AT, Harbo, T, Poulsen, MS, Ruiz de Morales Ayudarte, N, Damgaard, DW & Andersen, G 2018, 'Effects of centralizing acute stroke services: A prospective cohort study' Neurology, vol. 91, no. 3, pp. e235-e248. DOI: 10.1212/WNL.0000000000005822

APA

CBE

Hastrup S, Johnsen SP, Terkelsen T, Hundborg HH, von Weitzel-Mudersbach P, Simonsen CZ, Hjort N, Møller AT, Harbo T, Poulsen MS, Ruiz de Morales Ayudarte N, Damgaard DW, Andersen G. 2018. Effects of centralizing acute stroke services: A prospective cohort study. Neurology. 91(3):e235-e248. Available from: 10.1212/WNL.0000000000005822

MLA

Vancouver

Hastrup S, Johnsen SP, Terkelsen T, Hundborg HH, von Weitzel-Mudersbach P, Simonsen CZ et al. Effects of centralizing acute stroke services: A prospective cohort study. Neurology. 2018 Jul 17;91(3):e235-e248. Available from, DOI: 10.1212/WNL.0000000000005822

Author

Hastrup, Sidsel ; Johnsen, Søren Paaske ; Terkelsen, Thorkild ; Hundborg, Heidi Holmager ; von Weitzel-Mudersbach, Paul ; Simonsen, Claus Ziegler ; Hjort, Niels ; Møller, Anette Torvin ; Harbo, Thomas ; Poulsen, Marika S ; Ruiz de Morales Ayudarte, Noella ; Damgaard, Dorte Winther ; Andersen, Grethe. / Effects of centralizing acute stroke services: A prospective cohort study. In: Neurology. 2018 ; Vol. 91, No. 3. pp. e235-e248

Bibtex

@article{8e2145414d0242c18b0e88b4c2eb8080,
title = "Effects of centralizing acute stroke services: A prospective cohort study",
abstract = "OBJECTIVE: To investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).METHODS: The CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective {"}before-and-after{"} cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.RESULTS: Centralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95{\%} confidence interval 0.38-0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.CONCLUSIONS: Centralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.",
author = "Sidsel Hastrup and Johnsen, {S{\o}ren Paaske} and Thorkild Terkelsen and Hundborg, {Heidi Holmager} and {von Weitzel-Mudersbach}, Paul and Simonsen, {Claus Ziegler} and Niels Hjort and M{\o}ller, {Anette Torvin} and Thomas Harbo and Poulsen, {Marika S} and {Ruiz de Morales Ayudarte}, Noella and Damgaard, {Dorte Winther} and Grethe Andersen",
note = "Copyright {\circledC} 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.",
year = "2018",
month = "7",
day = "17",
doi = "10.1212/WNL.0000000000005822",
language = "English",
volume = "91",
pages = "e235--e248",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams & Wilkins",
number = "3",

}

RIS

TY - JOUR

T1 - Effects of centralizing acute stroke services: A prospective cohort study

AU - Hastrup,Sidsel

AU - Johnsen,Søren Paaske

AU - Terkelsen,Thorkild

AU - Hundborg,Heidi Holmager

AU - von Weitzel-Mudersbach,Paul

AU - Simonsen,Claus Ziegler

AU - Hjort,Niels

AU - Møller,Anette Torvin

AU - Harbo,Thomas

AU - Poulsen,Marika S

AU - Ruiz de Morales Ayudarte,Noella

AU - Damgaard,Dorte Winther

AU - Andersen,Grethe

N1 - Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

PY - 2018/7/17

Y1 - 2018/7/17

N2 - OBJECTIVE: To investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).METHODS: The CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective "before-and-after" cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.RESULTS: Centralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38-0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.CONCLUSIONS: Centralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

AB - OBJECTIVE: To investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR).METHODS: The CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective "before-and-after" cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014.RESULTS: Centralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38-0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark.CONCLUSIONS: Centralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.

U2 - 10.1212/WNL.0000000000005822

DO - 10.1212/WNL.0000000000005822

M3 - Journal article

VL - 91

SP - e235-e248

JO - Neurology

T2 - Neurology

JF - Neurology

SN - 0028-3878

IS - 3

ER -