title: Impact of stroke care unit on patient outcomes in a community hospital.
abstract: OBJECTIVE
  Geographically distinct multidisciplinary stroke care units (SCUs) have been shown by systematic reviews to have superior patient outcomes compared with conventional care in general medical wards. However, the effectiveness of SCUs in smaller North American community hospitals is less well defined. The objective of this study was to determine the impact of establishing a specialized SCU at a community hospital on patient outcomes.
  
  
  METHODS
  This is a retrospective cohort study of 805 patients with stroke admitted to 2 community hospitals in Edmonton, Canada, from 2003 to 2009 using an administrative database. Stroke was identified by International Classification of Disease, 10th Edition, codes. One of the community hospitals established a SCU on January 1, 2007. This date was used to subdivide the patient population into 2 cohorts: phase 1 from 2003 to 2006 and phase 2 from 2007 to 2009. Outcomes measured were mortality, discharge disposition, length of stay, and complications and were adjusted for age, sex, and medical comorbidities.
  
  
  RESULTS
  Patient mortality decreased significantly from 17.1% to 8.3% (adjusted odds ratio [OR], 0.54; 95% confidence interval [CI], 0.31-0.95) after SCU implementation, whereas it remained ≈19% at the control hospital. SCU also increased the odds that patients would be discharged home independently (adjusted OR, 2.17; 95% CI, 1.49-3.15; P<0.001] without increasing length of stay.
  
  
  CONCLUSIONS
  Establishing a SCU in a community hospital not only increases the survival of stroke patients, but also the proportion of patients discharged home to live independently. The benefits of SCU reported in larger tertiary centers extend to smaller community hospitals with more limited resources.
authors.affiliation: From the Department of Radiology and Diagnostic Imaging (A.T.) and Division of Neurology, Department of Medicine (M.S., A.S., K.B., R.J., M.M., B.H.B.), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tamm
authors.forename: Muzaffar
authors.initials: M
authors.lastname: Siddiqui
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Ken
authors.initials: K
authors.lastname: Butcher
authors.forename: Rajive
authors.initials: R
authors.lastname: Jassal
authors.forename: Mikael
authors.initials: M
authors.lastname: Muratoglu
authors.forename: Brian H
authors.initials: BH
authors.lastname: Buck
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006757:Hospital Units; D006764:Hospitals, Community / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: hospital units; outcome assessment (health care); stroke (acute)