Resource utilization and outcome at a university versus a community teaching hospital in tPA treated stroke patients: a retrospective cohort study.
BMC Health Serv Res
; 10: 44, 2010 Feb 19.
Article
en En
| MEDLINE
| ID: mdl-20170487
ABSTRACT
BACKGROUND:
Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA.METHODS:
Medical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG.RESULTS:
Seventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital.CONCLUSIONS:
Utilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Evaluación de Resultado en la Atención de Salud
/
Activador de Tejido Plasminógeno
/
Accidente Cerebrovascular
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
BMC Health Serv Res
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos