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.

A EuroHOPE kutatási program módszertana

“…Azokat a módszertani kérdéseket emeltük ki, amelyek a jelen lapszámban megjelenő AMI, STR, HIP és VLBW diagnóziscsoportokkal kapcsolatos közle ményeink értelmezéséhez szükségesek. A EuroHOPE kutatás egyéb területeit a nemzetközi publikációkból [3][4][5][6][7][8][9][10][11][12] és a kutatás honlapjáról lehet megismerni (http://www.eurohope.info). Az egyes diagnóziscso portok specifikus módszertani jellemzőit a témát ismer tető dolgozatokban közöljük.…”

“…A nemzetközi összehasonlító elemzéseket számos publi kációban [3][4][5][6][7][8][9][10][11][12] közöltük, a részletes publikációs jegy zék ugyancsak elérhető a EuroHOPE honlapján.…”

A Window on Geographic Variation in Health Care: Insights from EuroHOPE

“…It was shown that the choice of reference data had little impact on outcomes (Moger and Peltola, 2014). In studies reported in two papers, the regional-level analysis was supplemented with analyses using the pooled patient-level data from five countries (Hagen et al, 2015b;Peltola et al, 2015), whereas in the studies reported in two other papers, solely pooled patient-level data were used Kittelsen et al, 2015).…”

“…Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015). Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015).…”

“…The EuroHOPE project was conceived to study such geographic variation in healthcare practice and in outcomes of care. Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015). In addition, one study was carried out with the hospital as unit of analysis and including all diseases treated in the hospital (Kittelsen et al, 2015).…”