ArticleBMJ (Clinical research ed.)2019
Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data.
Article in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers.
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Who cites it
39 citing papers in PubMed.
- Effect of an Enhanced Paramedic Acute Stroke Treatment Assessment on Thrombolysis Delivery During Emergency Stroke Care: A Cluster Randomized Clinical Trial.JAMA neurology · 2020Trial
- The Role of Videoconferencing Teleconsultation in Improving Transfer Efficiency and Functional Outcomes in Rural Stroke Care: Retrospective Cohort Study.JMIR mHealth and uHealth · 2026Article
- Stroke survivors' and carers' experiences of nutritional care after stroke: a qualitative study.Frontiers in stroke · 2026Article
- Cost analysis of post-stroke dysphagia during acute hospitalisation: a cross-sectional study in Vietnam.BMJ open · 2025Article
- Impact of major stroke service centralisation on mortality and care: analysis of admissions, interventions and outcomes in South Australia.BMC health services research · 2025Article
- Psychometric evaluation of the mandarin version of the caregiver task inventory (CTI-45) for family caregivers of stroke survivors.BMC psychology · 2025Article
- Variations in Methodological Approaches to Measuring Health Inequalities and Inequities: A Scoping Review of Acute Stroke Pathways.Healthcare (Basel, Switzerland) · 2025Review
- Amyloid immunotherapy for Alzheimer's disease: the case for cautious adoption.Arquivos de neuro-psiquiatria · 2025Review
- [Cost-Effectiveness Analysis of an ICTUS Unit: A Case Study of the University Hospital Complex of Santiago de Compostela].Revista de neurologia · 2025Article
- Hyper-Acute Stroke Systems of Care and Workflow.Current neurology and neuroscience reports · 2024Review
- Regional variation in access to and quality of acute stroke care: results of Germany's Health System Performance Assessment pilot, 2014-2020.Research in health services & regions · 2024Article
- Results of an international survey on the status of prehospital care.International journal of stroke : official journal of the International Stroke Society · 2023Article
- Networks for future healthcare.Future healthcare journal · 2022Article
- Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study.Journal of health services research & policy · 2022Article
- Developing a taxonomy of care coordination for people living with rare conditions: a qualitative study.Orphanet journal of rare diseases · 2022Article
- National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.European stroke journal · 2022Article
- Development of models of care coordination for rare conditions: a qualitative study.Orphanet journal of rare diseases · 2022Article
- Grace Under Pressure: Resiliency of Quality Monitoring of Stroke Care During the Covid-19 Pandemic in Mexico City.Frontiers in neurology · 2022Article
- British Cardiovascular Interventional Society Consensus Position Statement on Out-of-Hospital Cardiac Arrest 1: Pathway of Care.Interventional cardiology (London, England) · 2022Review
- Association of Annual Intensive Care Unit Sepsis Caseload With Hospital Mortality From Sepsis in the United Kingdom, 2010-2016.JAMA network open · 2021Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
objectivesTo investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.
designRetrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).
settingAcute stroke services in Greater Manchester and London, England.
participants509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016.
interventionsHub and spoke models for acute stroke care.
main outcome measuresMortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions.
resultsIn Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences -1.8% (95% confidence interval -3.4 to -0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (-1.5 (-2.5 to -0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas.
conclusionsCentralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.
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