Department of Applied Health Research, University College London, London WC1E 7HB, UK.
Alliance Manchester Business School, University of Manchester, Manchester M15 6PB, UK.
BMJ. 2019 Jan 23;364:l1. doi: 10.1136/bmj.l1.
To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.
Retrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).
Acute stroke services in Greater Manchester and London, England.
509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016.
Hub and spoke models for acute stroke care.
Mortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions.
In Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences -1.8% (95% confidence interval -3.4 to -0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (-1.5 (-2.5 to -0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas.
Centralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.
调查 2015 年大曼彻斯特急性脑卒中服务进一步集中化是否与结局变化相关，以及 2010 年伦敦急性脑卒中服务集中化的效果是否持续。
对来自医院出院统计（HES）数据库的患者水平数据进行回顾性分析，并与来自国家统计局的死亡率数据以及 Sentinel Stroke 国家审计计划（SSNAP）进行链接。
英格兰大曼彻斯特和伦敦的急性脑卒中服务。
2008 年 1 月至 2016 年 3 月期间 HES 中居住在城区的 509182 例脑卒中患者；2013 年 4 月至 2016 年 3 月期间 SSNAP 中的 218120 例脑卒中患者。
急性脑卒中治疗的中心辐射模式。
住院后 90 天的死亡率；急性住院时间；超急性脑卒中单元的治疗；19 项基于证据的临床干预措施。
在大曼彻斯特，有边缘证据表明，风险调整后的 90 天死亡率总体上有所下降；在超急性脑卒中单元治疗的患者中，死亡率显著下降（差异-1.8%（95%置信区间-3.4 至-0.2）），表明每年减少 69 例死亡。整体风险调整后的急性住院时间明显缩短（-1.5（-2.5 至-0.4）天；P<0.01），表明每年减少 6750 个住院日。在超急性脑卒中单元接受治疗的患者比例从 2010-12 年的 39%增加到 2015/16 年的 86%。在伦敦，90 天死亡率保持不变（P>0.05），住院时间缩短（P<0.01），超过 90%的患者在超急性脑卒中单元接受治疗。两个地区的基于证据的临床干预措施的总体实施情况保持不变或有所改善。
集中化的急性脑卒中治疗模式，使所有脑卒中患者都能接受超急性治疗，可以降低死亡率和急性住院时间，并提高基于证据的临床干预措施的实施率。效果可以持续存在。
Zotero 插件
