title: Positive effects of tertiary centres for amyotrophic lateral sclerosis on outcome and use of hospital facilities.
abstract: OBJECTIVE
  To evaluate the effects of tertiary centres for amyotrophic lateral sclerosis (ALS) on ALS outcome and the use of hospital facilities.
  
  
  METHODS
  The study was based on the data of an epidemiological, prospective, population-based register on ALS (Piemonte and Valle d'Aosta Register for amyotrophic lateral sclerosis, PARALS). The 221 patients recruited between 1995 and 1996 were prospectively followed up for outcome and use of hospital-based services.
  
  
  RESULTS
  In all, 97 patients were followed up by tertiary ALS centres and 124 by general neurological clinics. Patients followed up by tertiary ALS centres were found to be 4 years younger and underwent percutaneous endoscopic gastronomy and non-invasive positive-pressure ventilation more often. Patients followed up by tertiary ALS centres were found to have a considerably longer median survival time (1080 v 775 days), even when stratifying by age, site of onset and respiratory function at diagnosis. In Cox multivariate analysis, attending a tertiary ALS centre was observed to be an independent positive prognostic factor. Moreover, patients attending a tertiary ALS centre were admitted to hospital less often (1.2 v 3.3) and were more frequently admitted for planned interventions. Conversely, patients followed up by general neurological clinics were more frequently admitted for acute events. Also, the hospital stay was considerably shorter for patients attending tertiary ALS centres (5.8 v 12.4 days).
  
  
  CONCLUSIONS
  Improved survival was seen in patients with ALS attending tertiary ALS centres, independently from all other known prognostic factors, possibly through a better implementation of supportive treatments. Moreover, because of these centres, the hospitalisation rate was markedly reduced, thus offering a cost-effective service to patients with ALS and to the community as a whole.
authors.affiliation: Divisione di Neurologia 1, Dipartimento di Neuroscienze, Università di Torino, Torino, Italy. achio@usa.net
authors.forename: A
authors.initials: A
authors.lastname: Chiò
authors.forename: E
authors.initials: E
authors.lastname: Bottacchi
authors.forename: C
authors.initials: C
authors.lastname: Buffa
authors.forename: R
authors.initials: R
authors.lastname: Mutani
authors.forename: G
authors.initials: G
authors.lastname: Mora
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000690:Amyotrophic Lateral Sclerosis / Q000534:rehabilitation*; D016021:Epidemiologic Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies