Quality of care and length of hospital stay among patients with stroke.
BACKGROUND
The relationship between quality of care and economic outcome measures, including length of stay (LOS), among patients with stroke remains to be clarified.


OBJECTIVE
To determine whether quality of care is associated with LOS among patients with stroke.


METHODS
In this population-based follow-up study, we included 2636 patients with stroke who had been admitted to dedicated stroke units in Aarhus County, Denmark, from 2003 to 2005. Quality of care was measured as fulfillment of 12 criteria: early admission to a stroke unit, early antiplatelet therapy, early anticoagulant therapy, early computed tomography/magnetic resonance imaging scan, early water swallowing test, early mobilization, early intermittent catheterization, early deep venous thromboembolism prophylaxis, early assessment by a physiotherapist and an occupational therapist, and early assessment of nutritional and constipation risk. Data were analyzed by linear regression clustered at the stroke units by multilevel modeling.


RESULTS
Median LOS was 13 days (25th and 75th percentiles: 7, 33). Meeting each quality of care criteria was associated with shorter LOS. Adjusted relative LOS ranged from 0.67 (95% confidence interval (CI): 0.61-0.73) to 0.87 (95% CI: 0.81-0.93). The association between meeting more quality of care criteria and LOS followed a dose-response effect, that is, patients who fulfilled between 75% and 100% of the quality of care criteria were hospitalized about one-half as long as patients who fulfilled between 0% and 24% of the criteria (adjusted relative LOS: 0.53, 95% CI: 0.48-0.59).


CONCLUSIONS
Higher quality of care during the early phase of stroke was associated with shorter LOS among patients with stroke.
Svendsen
Marie Louise
ML
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark. mls@dce.au.dk
Ehlers
Lars Holger
LH
Andersen
Grethe
G
Johnsen
Søren Paaske
SP
D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*