Multispecialty stroke services in California hospitals are associated with reduced mortality.
OBJECTIVE
To evaluate whether 1) a dedicated, multispecialty service, 2) a distinct hospital ward, 3) protocols, and 4) a specialist are associated with reduced mortality among patients with stroke.


METHODS
The authors reviewed data (1998 and 1999) from all acute, non-federal hospitals in California, including administrative discharge databases for patient and hospital-level information, mortality data through 1 year post discharge, and a hospital-level survey regarding structural elements of stroke care. The impact of a dedicated, multidisciplinary stroke service and of stroke wards, protocols, and specialists on odds of death among patients with ischemic and hemorrhagic stroke were each examined using logistic regression models. How these elements of care impacted outcome at teaching vs non-teaching hospitals was also examined.


RESULTS
A 67.5% response rate (257/381) from surveyed hospitals provided data for 61,541 patients with stroke. A dedicated, multispecialty stroke service was available at 7.4% of hospitals. Twelve percent of hospitals had a stroke ward, 62.3% used protocols, and 16% had neurologists with specialty training in stroke. Patients cared for at hospitals with a dedicated stroke service had significantly lower odds for death at 30 days, and reduced mortality was maintained through 365 days after admission. Stroke wards, protocols, and specialists were not associated with reduced mortality. Having a dedicated stroke service was associated with reduced mortality at both non-teaching and teaching hospitals.


CONCLUSIONS
Dedicated, multispecialty stroke services are underutilized despite their association with reduced stroke mortality at both academic and non-academic hospitals.
Michigan State University, East Lansing, USA. gretchen.birbeck@ht.msu.edu
Gretchen L
GL
Birbeck
David S
DS
Zingmond
Xinping
X
Cui
Barbara G
BG
Vickrey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand; D017052:Hospital Mortality; D006757:Hospital Units / Q000706:statistics & numerical data*; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome