Selective admission into stroke unit and patient outcomes: A tale of four cities

Farasat A S Bokhari, Ian Wellwood, Anthony G. Rudd, Peter Langhorne, Martin S. Dennis, Charles DA Wolfe

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
159 Downloads (Pure)

Abstract

Care of stroke patients costs considerably more in specialized stroke units (SU) compared to care in general medical wards (GMW) but the technology may be cost effective if it leads to significantly improved outcomes. While randomized control trials show better outcomes for stroke patients admitted to SU, observational studies report mixed findings. In this paper we use individual level data from first-ever stroke patients in four European cities and find evidence of selection by the initial severity of stroke into SU in some cities. In these cases, the impact of admission to SU on outcomes is overestimated by multivariate logit models even after controlling for case-mix. However, when the imbalance in patient characteristics and severity of stroke by admission to SU and GMW is adjusted using propensity score methods, the differences in outcomes are no longer statistically significant in most cases. Our analysis explains why earlier studies using observational data have found mixed results on the benefits of admission to SU.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalHealth Economics Review
Volume4
Issue number1
DOIs
Publication statusPublished - 9 Jan 2014

Keywords

  • Outcomes
  • Propensity score matching
  • Selection bias
  • Stroke unit care

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