title: Quality of care and patient outcome in stroke units: is medical specialty of importance?
abstract: BACKGROUND
  Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting.
  
  
  OBJECTIVE
  To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity.
  
  
  METHODS
  In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics.
  
  
  RESULTS
  Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant.
  
  
  CONCLUSIONS
  Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. mls@dce.au.dk
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Svendsen
authors.forename: Lars Holger
authors.initials: LH
authors.lastname: Ehlers
authors.forename: Morten
authors.initials: M
authors.lastname: Frydenberg
authors.forename: Annette
authors.initials: A
authors.lastname: Ingeman
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000368:Aged; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011787:Quality of Health Care; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
chemical_list: D010975:Platelet Aggregation Inhibitors