[Influence of institutional factors in neurological, medical and geriatric departments on length of stay in patients with stroke].
BACKGROUND
Length of hospital stay (LOS) is determined not only by medical procedures or complications but also by institutional factors. We examined the influence of various institutional factors in neurological, medical and geriatric departments on LOS in patients with ischemic stroke.


METHODS
We used data of 12,410 patients from the Westphalian Stroke Register for the years 2000 and 2001. Forty-two centres including 24 neurological, 13 medical and five geriatric departments participated in the register. The register is based on a standardized data assessment, including patient-related sociodemographic and clinical items, diagnostic and treatment procedures, complications, and status at discharge.


RESULTS
7855 patients with ischemic stroke from 37 centres (median age: 73 years, 51 % female) were included in the analysis. In neurological departments, the LOS decreased with increasing numbers of stroke patients treated per centre and year, presence of a stroke unit or a rehabilitation unit. Conversely, the ratio beds to number of physicians was positively associated with LOS. In geriatric departments, a significant decrease in LOS with an increasing number of stroke cases and availability of a rehabilitation unit was also observed. In departments of medicine, no significant influence on LOS was found for the institutional factors analysed.


CONCLUSIONS
Institutional factors have a significant influence on LOS in patients with stroke. In this analysis, the influence varied between the different medical specialties. Institutional factors gain importance in the management of stroke patients, when Diagnosis Related Groups (DRG) are introduced.
Schmidt
W-P
WP
Institut für Epidemiologie und Sozialmedizin, Universität Münster.
Berger
K
K
Taeger
D
D
Lay
M
M
Bücker-Nott
H-J
HJ
Kolominsky-Rabas
P
P
D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D005260:Female; D005853:Geriatrics; D005858:Germany; D006742:Hospital Bed Capacity; D006748:Hospital Departments; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009462:Neurology; D010820:Physicians / Q000600:supply & distribution; D012042:Registries; D012959:Socioeconomic Factors; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D000078329:Workforce