title: Regional variation in acute stroke care organisation.
abstract: BACKGROUND
  Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST).
  
  
  METHODS
  HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification.
  
  
  RESULTS
  94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals.
  
  
  CONCLUSIONS
  Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
authors.forename: Paula
authors.initials: P
authors.lastname: Muñoz Venturelli
authors.affiliation: Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Disease, University of Leicester, Leicester, UK.
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.affiliation: Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Lavados
authors.affiliation: Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
authors.forename: Verónica V
authors.initials: VV
authors.lastname: Olavarría
authors.affiliation: Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Laurent
authors.initials: L
authors.lastname: Billot
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; College of Health and Wellbeing, University of Central Lancashire, Preston, UK.
authors.forename: Maree L
authors.initials: ML
authors.lastname: Hackett
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Joyce Y
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia.
authors.forename: Sandy
authors.initials: S
authors.lastname: Middleton
authors.affiliation: Stroke Service, Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Octavio
authors.initials: O
authors.lastname: Pontes-Neto
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Peng
authors.affiliation: Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Liying
authors.initials: L
authors.lastname: Cui
authors.affiliation: Department of Neurology, Shanghai 85th Hospital of PLA, Shanghai, China.
authors.forename: Lily
authors.initials: L
authors.lastname: Song
authors.affiliation: Department of Geriatric Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Mead
authors.affiliation: College of Health and Wellbeing, University of Central Lancashire, Preston, UK; Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Watkins
authors.affiliation: Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan.
authors.forename: Ruey-Tay
authors.initials: RT
authors.lastname: Lin
authors.affiliation: Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.
authors.forename: Jeyaraj
authors.initials: J
authors.lastname: Pandian
authors.affiliation: Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: H Asita
authors.initials: HA
authors.lastname: de Silva
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia; The George Institute, China, Peking University Health Sciences Center, Beijing, China. Electronic address: canderson@georgeinstitute.org.au.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D002545:Brain Ischemia / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D002985:Clinical Protocols; D018592:Cross-Over Studies; D006280:Health Workforce / Q000191:economics; D006742:Hospital Bed Capacity / Q000191:economics; D006761:Hospitals; D006801:Humans; D010351:Patient Discharge / Q000191:economics; D056888:Patient Positioning; D011785:Quality Assurance, Health Care / Q000191:economics; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000191:economics
keywords: Acute ischemic stroke; In- and out-hospital stroke care organisation; Intracerebral hemorrhage; Stroke; Stroke care; Thrombolysis