Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party.
OBJECTIVE
To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke.


METHODS
Retrospective audit of case notes and service organization.


METHODS
Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland.


METHODS
The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit.


RESULTS
There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay.


CONCLUSIONS
There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.
Rudd
A G
AG
CEEU and Guy's and St Thomas' Hospital, London, UK. anthony.rudd@kcl.ac.uk
Irwin
P
P
Rutledge
Z
Z
Lowe
D
D
Wade
D T
DT
Pearson
M
M
D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D009660:Northern Ireland / Q000453:epidemiology; D010351:Patient Discharge; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D000071939:Stroke Rehabilitation; D014852:Wales / Q000453:epidemiology