[Acute and post-acute hospitalizations for stroke in France: recent improvements (2007-2009)]

The objectives of this study were to assess the main characteristics of acute and post-acute care for transient ischemic attack (TIA) and stroke, based on the French national hospitalization databases and their evolutions from 2007 through 2009.

Hospitalizations with a main diagnosis of stroke were first selected in the 2007, 2008 and 2009 French hospital discharge databases (PMSI-MCO). They were then linked in the corresponding national databases of post-acute hospitalization records (PA), through the common anonymous patient number used in every hospitalization database.

In France, 138,601 acute hospitalizations were registered in 2009, 31,674 TIA and 106,927 strokes, of which 91% were in public hospitals. The mean length of stay was 6.4 days for TIA and 12.7 days for stroke. Stroke hospitalization in stroke unit increased from 9.7% in 2007 to 25.9% in 2009 and acute care in hospital having a stroke unit, from 22.9% to 47.4%. A third of stroke patients hospitalized in acute care in 2009 (and not deceased), were linked in the post-acute-care database: 10.4% were in rehabilitations facilities (RF) and 23.4%, in post-acute nursing facilities (PAN), versus respectively 7.5% and 24% in 2007.

French national hospitalization databases are exhaustive (acute care) or quasi-exhaustive (post-acute care) and can be linked with a good reliability. However, their validity depends on coding accuracy. In this respect, stroke unit hospitalization might be underreported.

The French national hospital databases showed consistent improvements in stroke care in recent years. At the acute phase, there was an increase in stroke care in both stroke unit and hospital with stroke unit, due to the development of stroke care in France. Furthermore, the proportion of stroke patient discharged in rehabilitation facilities increased from 7.5% to 10.4%.