Trends and Regional Variation in Hospital Mortality, Length of Stay and Cost in Hospital of Ischemic Stroke Patients in Alberta Accompanying the Provincial Reorganization of Stroke Care.
OBJECTIVE
This study aimed to evaluate the trends and regional variation of stroke hospital care in 30-day in-hospital mortality, hospital length of stay (LOS), and 1-year total hospitalization cost after implementation of the Alberta Provincial Stroke Strategy.


METHODS
New ischemic stroke patients (N = 7632) admitted to Alberta acute care hospitals between 2006 and 2011 were followed for 1 year. We analyzed in-hospital mortality with logistic regression, LOS with negative binomial regression, and the hospital costs with generalized gamma model (log link). The risk-adjusted results were compared over years and between zones using observed/expected results.


RESULTS
The risk-adjusted mortality rates decreased from 12.6% in 2006/2007 to 9.9% in 2010/2011. The regional variations in mortality decreased from 8.3% units in 2008/2009 to 5.6 in 2010/2011. The LOS of the first episode dropped significantly in 2010/2011 after a 4-year slight increase. The regional variation in LOS was 15.5 days in 2006/2007 and decreased to 10.9 days in 2010/2011. The 1-year hospitalization cost increased initially, and then kept on declining during the last 3 years. The South and Calgary zones had the lowest costs over the study period. However, this gap was diminishing.


CONCLUSIONS
After implementation of the Alberta Provincial Stroke Strategy, both mortality and hospital costs demonstrated a decreasing trend during the later years of study. The LOS increased slightly during the first 4 years but had a significant drop at the last year. In general, the regional variations in all 3 indicators had a diminishing trend.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada. Electronic address: arto.ohinmaa@ualberta.ca.
Arto
A
Ohinmaa
Institute of Health Economics, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Yufei
Y
Zheng
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada.
Thomas
T
Jeerakathil
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Scott
S
Klarenbach
National Institute for Health and Welfare, Helsinki, Finland.
Unto
U
Häkkinen
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada.
Thanh
T
Nguyen
Alberta Medical Association, Edmonton, Alberta, Canada.
Dan
D
Friesen
West Virginia University, Morgantown, West Virginia.
Jane
J
Ruseski
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Padma
P
Kaul
Canadian Institute for Health Information, Ottawa, Ontario, Canada.
Ruolz
R
Ariste
Institute of Health Economics, Edmonton, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Philip
P
Jacobs
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D017046:Cost Savings / Q000639:trends; D003362:Cost-Benefit Analysis / Q000639:trends; D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000639:trends*; D017721:Hospital Costs / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000639:trends*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000639:trends; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics / Q000639:trends; D019984:Quality Indicators, Health Care / Q000191:economics / Q000639:trends; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Ischemic stroke; hospital cost; hospitalization; length of stay; mortality; regional variation; risk adjustment; trend