You are here

  • Home
  • Archive
  • Volume 9, Issue 9
  • Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study

Article Text

Article menu

Download PDFPDF

XML
Health economics
Original research
Variations in hospital resource use across stroke care teams in England, Wales and Northern Ireland: a retrospective observational study
  1. David G Lugo-Palacios1,
  2. Brenda Gannon2,
  3. Matthew Gittins3,
  4. Andy Vail3,
  5. Audrey Bowen4,
  6. Sarah Tyson5
  1. 1 Manchester Centre for Health Economics, University of Manchester, Manchester, UK
  2. 2 School of Economics & Centre for Business and Economics of Health, Faculty of Business,Economics and Law, The University of Queensland, Australia
  3. 3 Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  4. 4 Division of Neuroscience & Experimental Psychology, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  5. 5 Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
  1. Correspondence to Dr David G Lugo-Palacios; d.lugo-palacios{at}imperial.ac.uk

Abstract

Objective To identify the main drivers of inpatient stroke care resource use, estimate the influence of stroke teams on the length of stay (LoS) of its patients and analyse the variation in relative performance across teams.

Design For each of four types of stroke care teams, a two-level count data model describing the variation in LoS and identifying the team influence on LoS purged of patient and treatment characteristics was estimated. Each team effect was interpreted as a measure of stroke care relative performance and its variation was analysed.

Setting This study used data from 145 396 admissions in 256 inpatient stroke care teams between June 2013 and July 2015 included in the national stroke register of England, Wales and Northern Ireland—Sentinel Stroke National Audit Programme.

Results The main driver of LoS, and thus resource use, was the need for stroke therapy even after stroke severity was taken into account. Conditional on needing the therapy in question, an increase in the average amount of therapy received per inpatient day was associated with shorter LoS. Important variations in stroke care performance were found within each team category.

Conclusions Resource use was strongly associated with stroke severity, the need for therapy and the amount of therapy received. The variations in stroke care performance were not explained by measurable patient or team characteristics. Further operational and financial analyses are needed to unmask the causes of this unexplained variation.

  • length of stay
  • performance measurement
  • resource use
  • SSNAP
  • stroke

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-030426

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors DGL-P, BG and ST designed the study. DGL-P conducted the data management, the data analysis and the results interpretation. DGL-P and BG drafted the manuscript. MG contributed to the data management. BG, ST, MG, AV and AB provided further inputs and critically revised the manuscript before finalisation.

    • Funding This article presents independent research funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (grant reference number HS&DR Project:14/198/09).

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests AB was until 2016 a member of the Intercollegiate Stroke Working Party that produces SSNAP from which the SSNAPIEST data were drawn and her University salary is part-funded by a personal award from Stroke Association. All other authors declare that they have no competing interests.

    • Ethics approval Ethical approval was not required as the research presented in this manuscript comprises a secondary analysis of routinely collected anonymised clinical data.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data may be obtained from a third party and are not publicly available.

    • Patient consent for publication Not required.