Hospital size, remoteness and stroke outcome.

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Previous research indicates a link between stroke admission volume and patient outcomes.
• Small hospitals often serve remote populations, necessitating an examination of hospital remoteness in stroke care.
• This study investigates the relationship between hospital location and the quality of stroke management.

Purpose of the Study:

• To determine if hospital remoteness is associated with stroke care quality.
• To analyze national stroke data to assess the impact of location on stroke outcomes.
• To evaluate the correlation between hospital proximity to infrastructure and stroke treatment metrics.

Main Methods:

• Utilized data from the Irish National Audit of Stroke (INAS) for 23 stroke services.
• Analyzed average stroke admissions, adjusted mortality, thrombolysis rates, and door-to-needle (DTN) times (≤45 min).
• Quantified hospital remoteness by distance to the nearest hospital, neurointerventional center, and proximity to the national motorway network.

Main Results:

• No significant differences in mortality, thrombolysis rates, or DTN times were found between higher and lower volume stroke hospitals.
• Hospitals near motorways demonstrated significantly higher thrombolysis rates and faster DTN times.
• Increased distance to the next hospital correlated negatively with DTN times and thrombolysis rates.

Conclusions:

• Hospital remoteness is associated with poorer stroke outcome and management metrics.
• Proximity to major transport infrastructure, like motorways, positively influences stroke care delivery.
• The findings highlight the need to address geographical disparities in stroke treatment.