title: Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals.
abstract: OBJECTIVE
  In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance.
  
  
  METHODS
  Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals.
  
  
  RESULTS
  The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital.
  
  
  CONCLUSIONS
  In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.
authors: From the Riksstroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden. kjellasplund1@gmail.com.
authors: Kjell
authors: K
authors: Asplund
authors: From the Riksstroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors: Maria
authors: M
authors: Sukhova
authors: From the Riksstroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors: Per
authors: P
authors: Wester
authors: From the Riksstroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden.
authors: Birgitta
authors: B
authors: Stegmayr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D016000:Cluster Analysis; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization; D006764:Hospitals, Community; D006782:Hospitals, Special; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013548:Sweden; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Riksstroke; stroke; thrombolytic therapy