ArticlePloS one2013
Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
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Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Integrated care management for patients following acute stroke: a systematic review.QJM : monthly journal of the Association of Physicians · 2025Pooled it
- Centralization of post-resuscitation care after out-of-hospital cardiac arrest at cardiac arrest centres: a Danish nationwide follow-up study.Critical care (London, England) · 2026Article
- Integrated diagnostic algorithm for acute vertigo combining TiTrATE, STANDING, and HINTS: a validation study in the emergency department.Scientific reports · 2025Article
- Procedural volume is linearly associated with mortality, major complications, and readmissions in patients undergoing malignant brain tumor resection.Journal of neuro-oncology · 2024Article
- Single-cell RNA sequencing technology in human spermatogenesis: Progresses and perspectives.Molecular and cellular biochemistry · 2024Review
- The role of an integrated referral program for patients with liver disease: A network between hub and spoke centers.United European gastroenterology journal · 2024Article
- What would other emergency stroke teams do? Using explainable machine learning to understand variation in thrombolysis practice.European stroke journal · 2023Article
- Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations.BMC public health · 2023Article
- Brazilian Academy of Neurology practice guidelines for stroke rehabilitation: part I.Arquivos de neuro-psiquiatria · 2022Article
- Utilizing Implementation Science to Bridge Cerebrovascular Health Disparities: a Local to Global Perspective.Current neurology and neuroscience reports · 2022Review
- National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.European stroke journal · 2022Article
- How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England.Applied health economics and health policy · 2021Article
- Clinical Outcomes after Intravenous Alteplase in Elderly Patients with Acute Ischaemic Stroke: A Retrospective Analysis of Patients Treated at a Tertiary Neurology Centre in England from 2013 to 2018.Stroke research and treatment · 2021Article
- Article
- How do patients pass through stroke services? Identifying stroke care pathways using national audit data.Clinical rehabilitation · 2020Article
- Redesigning Care for OSA.Chest · 2020Review
- Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR).PLoS medicine · 2020Observational
- Centralising acute stroke care within clinical practice in the Netherlands: lower bounds of the causal impact.BMC health services research · 2020Article
- Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines.Open heart · 2020Observational
- Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study.Neuropsychiatric disease and treatment · 2020Article
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn July 2010 a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, UK, with continuous specialist care during the first 72 hours provided at 8 hyper-acute stroke units (HASUs) compared to the previous model of 30 local hospitals receiving acute stroke patients. We investigated differences in clinical outcomes and costs between the new and old models.
methodsWe compared outcomes and costs 'before' (July 2007-July 2008) vs. 'after' (July 2010-June 2011) the introduction of the new model, adjusted for patient characteristics and national time trends in mortality and length of stay. We constructed 90-day and 10-year decision analytic models using data from population based stroke registers, audits and published sources. Mortality and length of stay were modelled using survival analysis.
findingsIn a pooled sample of 307 patients 'before' and 3156 patients 'after', survival improved in the 'after' period (age adjusted hazard ratio 0.54; 95% CI 0.41-0.72). The predicted survival rates at 90 days in the deterministic model adjusted for national trends were 87.2% 'before' % (95% CI 86.7%-87.7%) and 88.7% 'after' (95% CI 88.6%-88.8%); a relative reduction in deaths of 12% (95% CI 8%-16%). Based on a cohort of 6,438 stroke patients, the model produces a total cost saving of £5.2 million per year at 90 days (95% CI £4.9-£5.5 million; £811 per patient).
conclusionA centralized model for acute stroke care across an entire metropolitan city appears to have reduced mortality for a reduced cost per patient, predominately as a result of reduced hospital length of stay.
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