Effects of centralizing acute stroke services: A prospective cohort study

Area of Science:

• Neurology
• Public Health
• Healthcare Management

Background:

• Acute stroke care delivery models are evolving.
• Centralization of specialized medical services is a strategy to improve efficiency and outcomes.
• The Central Denmark Region (CDR) implemented a centralization of acute stroke services.

Purpose of the Study:

• To evaluate the impact of centralizing acute stroke services in the CDR.
• To assess changes in length of hospital stay, access to care, and quality of care post-centralization.

Main Methods:

• Prospective "before-and-after" cohort study.
• Comparison of stroke cases within the CDR against the rest of Denmark using a difference-in-differences approach.
• Analysis of 22,141 stroke cases hospitalized between May 2011-April 2012 and May 2013-April 2014.

Main Results:

• Significant reduction in median acute hospital stay from 5 to 2 days (ratio 0.53).
• Increased same-day admissions for stroke patients, particularly outpatients.
• Improved quality of care across 11 performance measures, with comparable trends in the rest of Denmark.

Conclusions:

• Centralization of acute stroke care in the CDR effectively reduced hospital stay duration.
• The centralization did not compromise the quality of care, readmissions, or mortality rates.
• The model demonstrates successful efficiency gains in stroke service delivery.