Ageing Clinical and Experimental Research Group, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK.
Medical Statistics Team, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK.
BMJ Open. 2019 Apr 3;9(4):e024506. doi: 10.1136/bmjopen-2018-024506.
To determine whether stroke patients' acute hospital length of stay (AHLOS) varies between hospitals, over and above case mix differences and to investigate the hospital-level explanatory factors.
A multicentre prospective cohort study.
Eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network in the East of England, UK.
The study sample was systematically selected to include all consecutive patients admitted within a month to any of the eight hospitals, diagnosed with stroke by an accredited stroke physician every third month between October 2009 and September 2011.
AHLOS was defined as the number of days between date of hospital admission and discharge or death, whichever came first. We used a multiple linear regression model to investigate the association between hospital (as a fixed-effect) and AHLOS, adjusting for several important patient covariates, such as age, sex, stroke type, modified Rankin Scale score (mRS), comorbidities and inpatient complications. Exploratory data analysis was used to examine the hospital-level characteristics which may contribute to variance between hospitals. These included hospital type, stroke monthly case volume, service provisions (ie, onsite rehabilitation) and staffing levels.
A total of 2233 stroke admissions (52% female, median age (IQR) 79 (70 to 86) years, 83% ischaemic stroke) were included. The overall median AHLOS (IQR) was 9 (4 to 21) days. After adjusting for patient covariates, AHLOS still differed significantly between hospitals (p<0.001). Furthermore, hospitals with the longest adjusted AHLOS's had predominantly smaller stroke volumes.
We have clearly demonstrated that AHLOS varies between different hospitals, and that the most important patient-level explanatory variables are discharge mRS, dementia and inpatient complications. We highlight the potential importance of stroke volume in influencing these differences but cannot discount the potential effect of unmeasured confounders.
确定中风患者的急性住院时间（AHLOS）是否因病例组合差异而在医院之间有所不同，并研究医院层面的解释因素。
一项多中心前瞻性队列研究。
英国东英格兰安格利亚中风和心脏临床网络的 8 个国民保健服务急性医院信托。
研究样本是系统选择的，包括在 2009 年 10 月至 2011 年 9 月期间，每个月在 8 家医院中的任何一家住院、由认证的中风医生诊断为中风的连续患者。
AHLOS 定义为从入院日期到出院或死亡日期（以先到者为准）的天数。我们使用多元线性回归模型来研究医院（作为固定效应）与 AHLOS 之间的关联，调整了几个重要的患者协变量，如年龄、性别、中风类型、改良 Rankin 量表评分（mRS）、合并症和住院并发症。探索性数据分析用于检查可能导致医院之间差异的医院层面特征。这些特征包括医院类型、每月中风病例量、服务提供（即现场康复）和人员配备水平。
共纳入 2233 例中风入院患者（52%为女性，中位年龄（IQR）为 79（70 至 86）岁，83%为缺血性中风）。总的中位 AHLOS（IQR）为 9（4 至 21）天。在调整患者协变量后，AHLOS 仍在医院之间存在显著差异（p<0.001）。此外，AHLOS 最长的医院中风量较小。
我们清楚地表明，AHLOS 在不同医院之间存在差异，最重要的患者层面解释变量是出院时的 mRS、痴呆和住院并发症。我们强调中风量对这些差异的潜在重要性，但不能排除未测量混杂因素的潜在影响。
