[The organization of health care for stroke. The stroke units make the difference].
BACKGROUND
The advantages of care in stroke units (UI) are known, as are those of being in neurology wards as compared with the general medical wards, although to date there are no studies which make a comparative evaluation of the stroke team (EI) as compared with the UI with regard to benefits in care obtained by the patients.


METHODS
We made a sequential analysis from the stroke register comparing three groups of patients attended during the years 1994-1996. During 1994 the patients were attended in the neurology ward by the EI. In 1995 an acute UI was set up. The criteria for inclusion or exclusion, health staff and technical resources were similar. We analysed the average stay, complications, mortality, hospital costs, functional state and destination on discharge.


RESULTS
We included 1,491 patients: 435 (1994), 529 (1995) and 527 (1996). Comparing UI with EI we observed a reduced average stay (29.5%; p<0.001), fewer complications (47.8%; p<0.001), better functional state on discharge (Rankin 1 +/- 2 against 2 +/- 2; p<0.0001), increased transference to rehabilitation units (78%; p<0.001) with less long-term hospitalisation (22%; VS) and a reduction in costs ( up to 14.2%). There was no difference in mortality.


CONCLUSIONS
The UI is a better system of attendance than EI for the management of strokes, since it reduces the average stay, hospital complications and health costs, as well as permitting a better functional state on discharge. Therefore treatment in the UI makes the difference in prognosis for these patients and the institutional expenses.
Barreiro Tella
P
P
Servicio de Neurología. Unidad de ictus.; Hospital General Universitario La Paz, Madrid, 28046, España.
Díez Tejedor
E
E
Frank García
A
A
Lara Lara
M
M
Fuentes
B
B
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009462:Neurology / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000592:standards; D013030:Spain; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy*