title: Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries.
abstract: Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.
authors.affiliation: Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
authors.affiliation: Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Timo T
authors.initials: TT
authors.lastname: Seppälä
authors.affiliation: Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
authors.affiliation: Semmelweis University, Budapest, Hungary.
authors.forename: Éva
authors.initials: É
authors.lastname: Belicza
authors.affiliation: Centre for Research on Health and Social Care Management, Bocconi University, Milano, Italy.|Department of Sociology, Faculty of Social Sciences, Charles University, Prague, The Czech Republic.
authors.forename: Dino
authors.initials: D
authors.lastname: Numerato
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Fanny
authors.initials: F
authors.lastname: Goude
authors.affiliation: National Health Services, Edinburgh, Scotland.
authors.forename: Eilidh
authors.initials: E
authors.lastname: Fletcher
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Heijink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000191:economics / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D055815:Young Adult
keywords: Europe; cerebral infarction; length of stay; regional variation