title: Evaluation of stroke services in Anglia Stroke Clinical Network to examine the variation in acute services and stroke outcomes.
abstract: BACKGROUND
  Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors.
  
  
  METHODS
  We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses.
  
  
  CONCLUSIONS
  This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Sciences, Norwich, UK. phyo.k.myint@uea.ac.uk
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.forename: Gill M
authors.initials: GM
authors.lastname: Price
authors.forename: Garry R
authors.initials: GR
authors.lastname: Barton
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Metcalf
authors.forename: Rachel
authors.initials: R
authors.lastname: Hale
authors.forename: Genevieve
authors.initials: G
authors.lastname: Dalton
authors.forename: Stanley D
authors.initials: SD
authors.lastname: Musgrave
authors.forename: Abraham
authors.initials: A
authors.lastname: George
authors.forename: Raj
authors.initials: R
authors.lastname: Shekhar
authors.forename: Peter
authors.initials: P
authors.lastname: Owusu-Agyei
authors.forename: Kevin
authors.initials: K
authors.lastname: Walsh
authors.forename: Joseph
authors.initials: J
authors.lastname: Ngeh
authors.forename: Anne
authors.initials: A
authors.lastname: Nicholson
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Day
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
authors.forename: Max O
authors.initials: MO
authors.lastname: Bachmann
mesh_terms: D015331:Cohort Studies; D006296:Health Services; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D011446:Prospective Studies; D013222:State Medicine; D020521:Stroke / Q000628:therapy*; D011795:Surveys and Questionnaires; D006113:United Kingdom