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Health economics
Research
Hospital comparison of stroke care in Sweden: a register-based study
  1. Ingrid Lekander1,
  2. Carl Willers2,
  3. Elisabeth Ekstrand3,
  4. Mia von Euler4,
  5. Birgitta Fagervall-Yttling5,
  6. Lena Henricson6,
  7. Konstantinos Kostulas7,8,
  8. Mikael Lilja9,
  9. Katharina S Sunnerhagen10,
  10. Jörg Teichert11,
  11. Hélène Pessah-Rasmussen12
  1. 1 Ivbar Institute AB and Medical Management Center, LIME, Karolinska Institutet, Stockholm, Sweden
  2. 2 Ivbar Institute AB and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Health Sciences, Lund University, Lund, Sweden
  4. 4 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Karolinska Institutet Stroke research Network at Södersjukhuset, Stockholm, Sweden
  5. 5 Sweden Occupational Unions, Luleå, Sweden
  6. 6 Swedish Association of Speech and Language Pathologists, Stockholm, Sweden
  7. 7 Department of Neurology, Huddinge Unit, Karolinska University Hospital, Stockholm, Sweden
  8. 8 Department of Clinical Neuroscience, Neuro-Angiological Research Center, Karolinska Institutet, Stockholm, Sweden
  9. 9 Department of Public Health and Clinical Medicine, Family Medicine, Östersund, Umeå University, Östersund, Sweden
  10. 10 Institute of Neuroscience and Physiology, Rehabilitation medicine, University of Gothenburg, Gothenburg, Sweden
  11. 11 Department of Medicine, Landstinget Dalarna, Mora lasarett, Mora, Sweden
  12. 12 Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
  1. Correspondence to Dr Ingrid Lekander; ingrid.lekander{at}ivbar.com

Abstract

Background and purpose The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix).

Method Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke.

Results The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix.

Conclusion Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.

  • value-based healthcare
  • case-mix adjustment
  • inequalities
  • resource use
  • health outcomes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015244

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    Footnotes

    • Contributors CW and LI: performed the analysis and drafting of manuscript.

    • Funding Funding for this research was provided by Sveus, through the Ministry of Health and Social Affairs (Dnr S2012/8356/FS) and seven Swedish regional authorities. Sveus is a research collaboration where seven Swedish regions develop systems for value-based monitoring of healthcare. The overarching aim of Sveus is to stimulate value-driven, efficient and patient-centred healthcare. The work has been carried out for a number of different patient groups, of which stroke is one.

    • Competing interests IL and CW are employed by Ivbar Institute, a research company specialised in healthcare governance and analysis of healthcare data. IL also holds stock in Ivbar Institute. Remaining coauthors did not declare any conflicts of interest.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the Regional Ethical Review Board at Karolinska Institutet in Stockholm (2013/1541-31/5).

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

    • Data sharing statement Patient-level data may not be shared, as patient data regulations in Sweden and regulations of data holders do not allow for this.