Norwich Medical School, Faculty of Medicine & Health Sciences, Norwich, UK.
BMC Health Serv Res. 2011 Feb 28;11:50. doi: 10.1186/1472-6963-11-50.
Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors.
METHODS/DESIGN: We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses.
This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.
中风是发达国家的第三大致死原因，也是全球范围内导致长期残疾的主要原因。英国一系列全国性的中风审计突出了医院之间中风护理的差异。本研究旨在描述中风后结果的变化，并在考虑病例组合差异和个体预后因素后，确定与更好结果相关的服务特征。
方法/设计：我们将在英格兰东部的 8 家急性 NHS 信托中进行一项队列研究，中风后至少有一年的随访期。研究人群将是在研究期间住院的中风患者的系统选择代表性样本，在每家医院招募。我们将收集个体患者的预后特征、所接受的医疗保健、结果和护理成本数据，还将记录每个提供者组织的相关特征。将使用比例风险回归模型统计评估一年结局的决定因素，包括患者报告的结局。基线和随访时将使用自我（或代理）完成的 EuroQol（EQ-5D）问卷来衡量生活质量，以进行成本效用分析。
本研究将提供与急性中风住院后患者结局和医疗保健成本变化相关的卫生服务因素的观察数据。这将为未来的 RCT 奠定基础，通过确定有前途的卫生服务干预措施，评估招募和随访试验患者的可行性，并提供关于结局的频率和变异性以及结局的组内相关性的证据，以进行样本量计算。研究结果将为临床医生、公众、服务提供者、决策者提供信息，以推动卫生服务的进一步改善，为患者带来直接利益。
