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The European Journal of Public Health 2000 10(2):120-126; doi:10.1093/eurpub/10.2.120
© 2000 by European Journal of Public Health
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METHODS

Putting stroke outcomes into context

Assessment of variations in the processes of care

CHRISTOPHER J. MCKEVITT1,, ROGER BEECH2, PANDORA POUND1, ANTHONY G. RUDD3, CHARLES D.A. WOLFE1 and ON BEHALF OF THE PARTICIPANTS OF THE BIOMED II EUROPEAN STUDY OF STROKE CARE

1Department of Public Health Sciences, Guy's, King's and St Thomas' Hospitals Medical School King's College London, UK
2Centre for Health Planning and Management, University of Keele UK
3Department of Elderly Care Medkine, St Thomas' Hospital London, UK

Correspondence: Dr C. McKevitt, Department of Public Health Sciences, Guy's, King's and St Thomas' Hospitals Medical School, Capital House, 42 Weston Street, London SE1 3QD, UK, tel. 0171 9552084, fax 0171 9281468, e-mail: christopher.mckevitt{at}kcl.ac.uk

Background: Comparative studies of patient outcomes consistently find that variations cannot be explained by case mix alone, suggesting that differences in the process of care may contribute to variations in outcome. We sought to describe local medical and social services available to patients participating in a multinational study of stroke services and outcomes. Methods: Key informant interviews were conducted with service providers in participating centres. A semi-structured interview schedule was used to describe local models of clinical care, types of community care available and the role of the family in caring for patients. Results: Data were provided by 15 centres in 14 European states. Models of clinical care include multidisciplinary and ‘geographical’ stroke units, dedicated stroke beds, neurologist-led care and physician-led care. Nurse to patient ratios range from 1:3 to 1:15. Three patterns of rehabilitation provision emerge and estimates of acute physiotherapy range from 30 to 180 min/day. In almost all centres the patient's family is expected to assume responsibility for care after discharge but there are wide variations in the levels of community support available to informal carers. Conclusions: The extent to which the structures and processes of care vary across a sample of European centres highlights the need for caution in assuming that studies which control for patient characteristics thereby control for all relevant variables. There are also implications for the implementation of international gold standards of care. Future analyses will relate our findings to 3 month and 1 year outcomes and assess their impact.

Keywords: delivery of health care, Europe, outcome and process assessment, stroke


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