Methodological issues in monitoring health services and outcomes for stroke survivors: a case study.
BACKGROUND
Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation.


OBJECTIVE
The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany.


METHODS
This study used qualitative and quantitative methods to study health resources available to and utilized by stroke survivors during the first 12 months post-stroke in two Italian health authorities (AUSL10 and 11). Mortality rates were used as an outcome measure.


RESULTS
Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared to AUSL 11. There was no significant difference between mortality rates.


CONCLUSIONS
Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.
Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland, USA. stuart@umbc.edu
Mary
M
Stuart
Donato
D
Papini
Francesco
F
Benvenuti
Marco
M
Nerattini
Enrico
E
Roccato
Velio
V
Macellari
Steven
S
Stanhope
Richard
R
Macko
Michael
M
Weinrich
D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000379:methods; D003657:Decision Making; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006291:Health Policy; D006305:Health Status Indicators; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D036301:Qualitative Research; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy / Q000401:mortality*; D000071939:Stroke Rehabilitation; D017741:Survivors; D016896:Treatment Outcome