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Inequalities in Stroke Patients' Management in English Public Hospitals: A Survey on 200,000 Patients

Lazzarino, AI; Palmer, W; Bottle, A; Aylin, P; (2011) Inequalities in Stroke Patients' Management in English Public Hospitals: A Survey on 200,000 Patients. PLOS ONE , 6 (3) , Article e17219. 10.1371/journal.pone.0017219. Green open access


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Background: According to clinical guidelines, every patient affected by stroke should be given a brain-imaging scan (BIS) Computerized Tomography or Magnetic Resonance Imaging - immediately after being admitted to hospital.Aim of the study: To describe the variation in use of BIS among English public hospitals and identify any patient groups being excluded from appropriate care.Methods: We collected hospital administrative data for all patients admitted to any English public hospital with a principal diagnosis of stroke from 2006 to 2009. We calculated the proportion of patients treated with BIS in the whole sample and after stratification by hospital. We compared hospitals' performance using funnel plots. We performed a multiple logistic regression analysis using BIS as outcome and age, gender, socio-economic deprivation, and comorbidity as covariates.Results: In English public hospitals there are about 70,000 emergency admissions for stroke per year. Nationally, only 35% receive a BIS immediately, and only 84% receive it within the admission. There is large variation in the use of BIS for stroke patients among English public hospitals, with some of them approaching the recommended 100% and some having very low rates. Young (P < 0.001), male (P=0.012), and least socio-economically deprived patients (P=0.001), as well as patients with fewer comorbidities (P < 0.001) appear to have more chance of being selected for a brain scan.Conclusion: Some English public hospitals appear to be falling well below the clinical guideline standards for scanning stroke patients and inappropriate patient selection criteria may be being applied, leading to health inequalities.

Type: Article
Title: Inequalities in Stroke Patients' Management in English Public Hospitals: A Survey on 200,000 Patients
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0017219
Publisher version: http://dx.doi.org/10.1371/journal.pone.0017219
Language: English
Additional information: © 2011 Lazzarino et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. WP, AB, and PA have support from the Dr Foster Unit at Imperial College London for the submitted work. The Dr Foster Unit at Imperial College is funded by the Dr Foster intelligence, an independent health care information company. The Dr Foster Unit at Imperial is affiliated with the Imperial Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust, which is funded by the National Institute of Health Research. The Department of Primary Care and Public Health is grateful for support from the National Institute for Health Research Biomedical Research Centre Funding Scheme. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
UCL classification: UCL
URI: https://discovery.ucl.ac.uk/id/eprint/1301650
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