ArticleBMC health services research2018
Stroke units, certification, and outcomes in German hospitals: a longitudinal study of patient-based 30-day mortality for 2006-2014.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Worldwide 1-month case fatality of ischaemic stroke and the temporal trend.Stroke and vascular neurology · 2020Pooled it
- Association of stroke unit certification with process quality in acute ischemic stroke: a registry-based study.Neurological research and practice · 2026Article
- The PopGrouper as a tool for morbidity adjustment in regional comparisons of health care: an analytical framework.Research in health services & regions · 2025Article
- Cross-Country Inequalities in Disease Burden and Quality of Care of Stroke, 1990-2021: A Systematic Analysis of the Global Burden of Disease Study 2021.European journal of neurology · 2025Article
- Observational
- Stroke in Ghana: A Situational Analysis.Stroke research and treatment · 2025Review
- Decomposing door-to-needle time: insights into workflow delays and quality improvement in acute stroke care.Frontiers in neurology · 2025Article
- Treatment in certified cancer centers is related to better survival in patients with colon and rectal cancer: evidence from a large German cohort study.World journal of surgical oncology · 2024Article
- Robotic-assisted surgery for prostatectomy - does the diffusion of robotic systems contribute to treatment centralization and influence patients' hospital choice?Health economics review · 2023Article
- [Specialization of Acute Stroke Care in Germany: Structural Changes During 2006-2017].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2023Article
- Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals.Journal of medical Internet research · 2022Article
- [Organ donation-Not only a responsibility of intensive care medicine].Der Anaesthesist · 2022Review
- Quality Assurance Measures and Mortality After Stroke.Deutsches Arzteblatt international · 2021Article
- Stroke-unit care for stroke patients in China: the results from Bigdata Observatory platform for Stroke of China.Journal of neurology · 2021Article
- Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective.International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation · 2020Article
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5 authors.
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Abstract
backgroundTreatment of stroke patients in stroke units has increased and studies have shown improved outcomes. However, a large share of patients in Germany is still treated in hospitals without stroke unit. The effects of stroke unit service line, and total hospital quality certification on outcomes remain unclear.
methodsWe employ annual hospital panel data for 1100-1300 German hospitals from 2006 to 2014, which includes structural data and 30-day standardized mortality. We estimate hospital- and time-fixed effects regressions with three main independent variables: (1) stroke unit care, (2) stroke unit certification, and (3) total hospital quality certification.
resultsOur results confirm the trend of decreasing stroke mortality ratios, although to a much lesser degree than previous studies. Descriptive analysis illustrates better stroke outcomes for non-certified and certified stroke units and hospitals with total hospital quality certification. In a fixed effects model, having a stroke unit has a significant quality-enhancing effect, lowering stroke mortality by 5.6%, while there is no significant improvement effect for stroke unit certification or total hospital quality certification.
conclusionsPatients and health systems may benefit substantially from stroke unit treatment expansion as installing a stroke unit appears more meaningful than getting it certified or obtaining a total hospital quality certification. Health systems should thus prioritize investment in stroke unit infrastructure and centralize stroke care in stroke units. They should also prioritize patient-based 30-day mortality data as it allows a more realistic representation of mortality than admission-based data.
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