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Main Title: Stroke units, certification, and outcomes in German hospitals: a longitudinal study of patient-based 30-day mortality for 2006–2014
Author(s): Pross, Christoph
Berger, Elke
Siegel, Martin
Geissler, Alexander
Busse, Reinhard
Type: Article
Language Code: en
Abstract: Background Treatment of stroke patients in stroke units has increased and studies have shown improved outcomes. However, a large share of patients in Germany is still treated in hospitals without stroke unit. The effects of stroke unit service line, and total hospital quality certification on outcomes remain unclear. Methods We employ annual hospital panel data for 1100–1300 German hospitals from 2006 to 2014, which includes structural data and 30-day standardized mortality. We estimate hospital- and time-fixed effects regressions with three main independent variables: (1) stroke unit care, (2) stroke unit certification, and (3) total hospital quality certification. Results Our results confirm the trend of decreasing stroke mortality ratios, although to a much lesser degree than previous studies. Descriptive analysis illustrates better stroke outcomes for non-certified and certified stroke units and hospitals with total hospital quality certification. In a fixed effects model, having a stroke unit has a significant quality-enhancing effect, lowering stroke mortality by 5.6%, while there is no significant improvement effect for stroke unit certification or total hospital quality certification. Conclusions Patients and health systems may benefit substantially from stroke unit treatment expansion as installing a stroke unit appears more meaningful than getting it certified or obtaining a total hospital quality certification. Health systems should thus prioritize investment in stroke unit infrastructure and centralize stroke care in stroke units. They should also prioritize patient-based 30-day mortality data as it allows a more realistic representation of mortality than admission-based data.
Issue Date: 22-Nov-2018
Date Available: 29-Nov-2018
DDC Class: 610 Medizin und Gesundheit
Subject(s): stroke
stroke unit
hospital specialization
stroke outcomes
Sponsor/Funder: TU Berlin, Open-Access-Publikationsfonds – 2018
DFG, 323809466, Ergebnistransparenz und deren Auswirkung auf die Versorgungsqualität in Krankenhäusern
Journal Title: BMC Health Services Research
Publisher: BioMed Central
Publisher Place: London
Volume: 18
Issue: 1
Article Number: 880
Publisher DOI: 10.1186/s12913-018-3664-y
ISSN: 1472-6963
Appears in Collections:FG Management im Gesundheitswesen » Publications

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