title: Variations in acute stroke care and the impact of organised care on survival from a European perspective: the European Registers of Stroke (EROS) investigators.
abstract: BACKGROUND
  The need for stroke care is escalating with an ageing population, yet methods to estimate the delivery of effective care across countries are not standardised or robust. Associations between quality and intensity of care and stroke outcomes are often assumed but have not been clearly demonstrated.
  
  
  OBJECTIVE
  To examine variations in acute care processes across six European populations and investigate associations between the delivery of care and survival.
  
  
  METHODS
  Data were obtained from population-based stroke registers of six centres in France, Lithuania, UK, Spain, Poland and Italy between 2004 and 2006 with follow-up for 1 year. Variations in the delivery of care (stroke unit, multidisciplinary team and acute drug treatments) were analysed adjusting for case mix and sociodemographic factors using logistic regression methods. Unadjusted and adjusted survival probabilities were estimated and stratified by levels of Organised Care Index.
  
  
  RESULTS
  Of 1918 patients with a first-ever stroke registered, 30.7% spent more than 50% of their hospital stay in a stroke unit (13.9-65.4%) among centres with a stroke unit available. The percentage of patients assessed by a stroke physician varied between 7.1% and 96.6%. There were significant variations after adjustment for confounders, in the organisation of care across populations. Significantly higher probabilities of survival (p<0.01) were associated with increased organisational care.
  
  
  CONCLUSIONS
  This European study demonstrated associations between delivery of care and stroke outcomes. The implementation of evidence-based interventions is suboptimal and understanding better ways to implement these interventions in different healthcare settings should be a priority for health systems.
authors: Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, 5th floor, Capital House, 42 Weston Street, London SE1 3QD, UK. salma.ayis@kcl.ac.uk
authors: Salma Ahmed
authors: SA
authors: Ayis
authors: Bolaji
authors: B
authors: Coker
authors: Ajay
authors: A
authors: Bhalla
authors: Ian
authors: I
authors: Wellwood
authors: Anthony G
authors: AG
authors: Rudd
authors: Antonio
authors: A
authors: Di Carlo
authors: Yannick
authors: Y
authors: Bejot
authors: Danuta
authors: D
authors: Ryglewicz
authors: Daiva
authors: D
authors: Rastenyte
authors: Peter
authors: P
authors: Langhorne
authors: Martin S
authors: MS
authors: Dennis
authors: Christopher
authors: C
authors: McKevitt
authors: Charles D A
authors: CD
authors: Wolfe
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011044:Poland / Q000453:epidemiology; D012042:Registries; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Cerebrovascular Disease; Evidence-Based Neurology; Health Policy & Practice; Stroke