Regional variation in acute stroke care organisation

Area of Science:

• Global Health
• Neurology
• Health Services Research

Background:

• Limited data exists on regional variations in stroke service organization, including healthcare resources, protocols, and discharge planning.
• This study compares stroke care organization in middle-income countries (MIC) and high-income countries (HIC) within the Head Position in Stroke Trial (HeadPoST).

Purpose of the Study:

• To compare the organization of stroke care between hospitals in middle-income countries (MIC) and high-income countries (HIC).
• To identify differences in healthcare resourcing, protocols, and discharge planning for stroke patients.

Main Methods:

• Utilized data from the Head Position in Stroke Trial (HeadPoST) international multicenter trial.
• A stroke care organization questionnaire was administered to participating hospitals.
• Hospitals were classified as MIC or HIC based on World Bank gross national income per capita criteria.

Main Results:

• 94 hospitals (51 MIC, 43 HIC) completed the questionnaire.
• HIC hospitals demonstrated significantly higher rates of patients arriving within 4 hours of symptom onset (41% vs. 13%) and receiving intravenous thrombolysis for acute ischemic stroke (10% vs. 5%).
• While most hospitals had dedicated stroke units and access to physicians, HIC hospitals offered greater access to a wider range of rehabilitation therapists compared to MIC hospitals.

Conclusions:

• All participating hospitals provided advanced stroke care, but significant organizational and treatment differences exist between MIC and HIC settings.
• Further multilevel analyses are planned to investigate the impact of specific organizational factors on patient outcomes.