[Length of hospital stay of patients with ischemic brain infarction:  trends over 10 years and analysis of influencing factors].
BACKGROUND
The length of the acute hospital stay (LOS) is an indicator of efficiency in the treatment of ischemic brain infarctions (ICD I63). The aim of this study was to describe the development of the LOS over 10 years and to analyze influencing factors with a focus on the structural level of hospitals.


METHODS
Routine treatment data for the years 2000 to 2009 generated within the quality assurance project "Stroke Register Northwest Germany" formed the basis of our analyses (n = 175,149). Additionally, the infrastructure and equipment of the hospitals were documented. Information regarding the bed density on county level was provided by the statistical offices of the federal German states. The median LOS was calculated for each year. Moreover, a linear multilevel analysis of the influencing factors stratified by hospital specialty was performed.


RESULTS
The LOS after an ischemic brain infarction decreased by several days over the years 2000 to 2009. The difference between the specialties neurology vs. internal and geriatric medicine diminished. A small part of variation in LOS was explained by the factors measured on the three levels patient, hospital and county. The biggest proportion of variance was explained by socio-demographic and clinical factors measured on patient level. Hospital equipment contributed somewhat additionally to the explanation of variance for hospitals specializing in internal and geriatric medicine. There were differences between the medical specialties both with regard to the associations observed and the distribution of variance on the three levels.


CONCLUSIONS
There was a reduction of the LOS in patients with ischemic brain infarction. A stratified analysis according to medical specialty seems necessary. Single features of the hospital infrastructure are associated with the LOS. However, the interpretation of these associations is in part difficult.
Institut für Epidemiologie und Sozialmedizin, Westfälische Wilhelms-Universität Münster. unrathm@uni-muenster.de
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M
Unrath
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M
Kalic
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K
Berger
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005858:Germany; D006302:Health Services Research / Q000706:statistics & numerical data; D006739:Hospital Administration / Q000639:trends; D006782:Hospitals, Special / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012042:Registries