Impact of introducing neurology into a local hospital in Andalusia.
BACKGROUND
The stroke mortality rate in Andalusia is twice that of other autonomous communities. This could be associated with the absence of neurologists in most local hospitals in this community, unlike in the rest of Spain. The objective of this study was to evaluate the impact of incorporating a neurologist to evaluate and monitor stroke patients in a local hospital in Andalusia.


METHODS
An observational study was conducted on stroke cases admitted in the first quarter of 2006. Quality indicators, mortality rates, and incapacity rates at follow-up were analysed, comparing groups with and without neurological care.


RESULTS
A total of 116 stroke patients were admitted. There were significant differences in tests performed to diagnose patients (Doppler and echocardiography). The mean hospital stay was significantly lower with neurology care. There was a 39.1% absolute decrease in mortality and a 35.7% absolute increase in capacity for daily life activities was also observed. Neurological care and a lower incapacity level at admission were the only two factors independently associated with a decrease in length of hospital stay and mortality


CONCLUSIONS
Specialised care by a neurologist is effective in reducing length of hospital stay, mortality and incapacity. The incorporation of neurologists in local hospitals in Andalusia should be a priority to guarantee equal care in all autonomous communities in Spain. This objective should be included in the Plan Andaluz de Atención al Ictus as a first step in forming a network of stroke units and teams.
Unidad de Gestión Clínica de Neurología Intercentros, Hospital Juan Ramón Jiménez y Hospital Infanta Elena, Huelva, Spain. emmartinezf@yahoo.es
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E
Martínez Fernández
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Sanz Fernández
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A
Blanco Ollero
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000639:trends*; D010820:Physicians; D019984:Quality Indicators, Health Care; D020127:Recovery of Function; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013038:Specialization; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome