[Hospitalizations for acute cerebrovascular accidents and transient ischemic attacks in Spain: temporal stability and spatial heterogeneity, 1998-2003]. / Hospitalizaciones por accidentes cerebrovasculares agudos y ataques isquémicos transitorios en España: estabilidad temporal y heterogeneidad espacial en el período 1998-2003.

INTRODUCTION: Stroke is a leading cause of hospitalisation. Ageing and differences in management and specialisation between health centres could explain the variability in hospitalisation and prognosis between areas. We analyse the number of hospitalisations due to stroke and TIA (Spain), 1998-2003, and the differences between regions. METHODS: The Spanish Ministry of Health, through its MBDS (Minimum Basic Data Set Office), provided data for stroke and TIA hospitalisation. Diagnoses were extracted according to ICD-9 (International Classification of Diseases) -codes 430-439- and to GRD (Group Related Diagnoses) -codes 14-17, 532, 810-. We included: a) autonomous community identification; b) average stay; c) age, sex, type of discharge (mortality); d) number of diagnoses, weight/cost for GRD. RESULTS: There was ateady temporal incidence of hospitalisation for stroke (GRD14, 160/100,000) and TIA (GRD15, 55/100,000). Weight and costs increased between 2000 and 2003, and reached 3,400 euro (GRD14) and 2,400 euro (GRD15). Average stay decreased from 12 to 10.1 days (stroke) and 8.6 to 7.3 days (TIA). Mortality also decreased from 12.7% to 9.2% for stroke (GRD14). The average number of diagnoses was similar for stroke and TIA: both increased from 4 to 5 over the 6 years. There were wide variations between autonomous communities in hospitalisations for stroke and TIA: from 250/100,000 to less than 120/100,000. There was a correlation between the ageing of the populations and these differences. There were also wide variations (up to 40%) in average stay and mortality between communities. CONCLUSIONS: Hospitalisation rate for stroke and TIA is very high and sustained; despite increasing complexity, average stay and mortality improved, which points to better management. Variability among regions is highlighted. Further prospective studies are required.

Hospitalizaciones por accidentes cerebrovasculares agudos y ataques isquémicos transitorios en España: estabilidad temporal y heterogeneidad espacial en el período 1998-2003 / Hospital admissions due to stroke and TIA in Spain: temporal stability and spatial heterogeneity in the period 1998-2003

Introducción: Los accidentes cerebrovasculares agudos (ACVA) son causa común de hospitalización. Por diferencias de envejecimiento y de especialización y manejo, es previsible heterogeneidad en ingresos y pronóstico entre áreas geográficas. El objetivo es determinar número de hospitalizaciones por ACVA y ataques isquémicos transitorios (AIT), 1998-2003 (España), y las diferencias entre comunidades autónomas. Métodos: La oficina CMBD (Ministerio de Sanidad) proporcionó información de ingresos por ACVA y AIT, mediante códigos relacionados de la clasificación ICD-9 (430-439) y GRD (14-17, 532, 810). Incluimos: a) identificación de comunidad autónoma; b) estancia media; c) edad, sexo y tipo de alta (mortalidad), y d) número de diagnósticos, peso y coste por GRD. Resultados: Incidencia estable de hospitalización, para ACVA (GRD14, 160/100.000) y para AIT (GRD15, 55/100.000). Peso y costes se incrementaron entre 2000 y 2003: alcanzaron 3.400 euros (GRD14, infarto no complicado) y 2.400 euros (GRD15, AIT). La estancia media tuvo tendencia decreciente: 12 a 10,1 días (ACVA) y de 8,6 a 7,3 días (AIT). Asimismo, hubo un descenso de la mortalidad, del 12,7 al 9,2% para ACVA (GRD14). El número de diagnósticos, similar para ACVA y AIT, pasó de 4 a 5 en el intervalo analizado. Hubo gran variabilidad en hospitalizaciones por ACVA y AIT entre comunidades: de 250/100.000 a menos de 120/100.000. El diferente envejecimiento de poblaciones se correlacionó directamente con estas diferencias, al igual que en estancia media y en mortalidad, que alcanzaron el 40% entre comunidades autónomas. Conclusiones: El porcentaje de hospitalizaciones por ACVA es muy alto y mantenido. A pesar de aumentar la complejidad, la estancia media y la mortalidad han mejorado, lo que apunta a mejor manejo. Debe subrayarse la variabilidad de resultados entre comunidades; merece ser analizada con estudios prospectivos

Introduction: Stroke is a leading cause of hospitalisation. Ageing and differences in management and specialisation between health centres could explain the variability in hospitalisation and prognosis between areas. We analyse the number of hospitalisations due to stroke and TIA (Spain), 1998-2003, and the differences between regions. Methods: The Spanish Ministry of Health, through its MBDS (Minimum Basic Data Set Office), provided data for stroke and TIA hospitalisation. Diagnoses were extracted according to ICD-9 (International Classification of Diseases) -codes 430-439- and to GRD (Group Related Diagnoses) -codes 14-17, 532, 810-. We included: a) autonomous community identification; b) average stay; c) age, sex, type of discharge (mortality); d) number of diagnoses, weight/ cost for GRD. Results: There was ateady temporal incidence of hospitalisation for stroke (GRD14, 160/100,000) and TIA (GRD15, 55/100,000). Weight and costs increased between 2000 and 2003, and reached 3,400 euro (GRD14) and 2,400 euro (GRD15). Average stay decreased from 12 to 10.1 days (stroke) and 8.6 to 7.3 days (TIA). Mortality also decreased from 12.7% to 9.2% for stroke (GRD14). The average number of diagnoses was similar for stroke and TIA: both increased from 4 to 5 over the 6 years. There were wide variations between autonomous communities in hospitalisations for stroke and TIA: from 250/100,000 to less than 120/100,000. There was a correlation between the ageing of the populations and these differences. There were also wide variations (up to 40%) in average stay and mortality between communities. Conclusions: Hospitalisation rate for stroke and TIA is very high and sustained; despite increasing complexity, average stay and mortality improved, which points to better management. Variability among regions is highlighted. Further prospective studies are required. Results: There was ateady temporal incidence of hospitalisation for stroke (GRD14, 160/100,000) and TIA (GRD15, 55/100,000). Weight and costs increased between 2000 and 2003, and reached 3,400 euro (GRD14) and 2,400 euro (GRD15). Average stay decreased from 12 to 10.1 days (stroke) and 8.6 to 7.3 days (TIA). Mortality also decreased from 12.7% to 9.2% for stroke (GRD14). The average number of diagnoses was similar for stroke and TIA: both increased from 4 to 5 over the 6 years. There were wide variations between autonomous communities in hospitalisations for stroke and TIA: from 250/100,000 to less than 120/100,000. There was a correlation between the ageing of the populations and these differences. There were also wide variations (up to 40%) in average stay and mortality between communities. Conclusions: Hospitalisation rate for stroke and TIA is very high and sustained; despite increasing complexity, average stay and mortality improved, which points to better management. Variability among regions is highlighted. Further prospective studies are required (AU)

Gestión clínica: de la práctica clínica a la gestión de los recursos / Clinical management: from clinical practice to resource management

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