Healthcare Resources, In-Hospital Management Measures, and Outcomes for Acute Ischemic Stroke in China: A...

To assess how province-level healthcare resource configuration relates to in-hospital management and outcomes for acute ischemic stroke in China.

We conducted a cross-sectional study of 1 055 971 adults with acute ischemic stroke treated at 1456 secondary and tertiary hospitals in the Chinese Stroke Center Alliance, 2015 to 2019. Hospital-level management and outcome measures were linked to province-level resource indicators from the China Health Statistics Yearbook, including physician:nurse ratio, nurse:bed ratio, density of medical institutions, and total health expenditure. Associations were estimated using patient-number-weighted linear regression models adjusted for hospital level, provincial gross regional product per capita, admission timing, and year, with cluster-robust standard errors at the province level.

Substantial interprovincial variation was observed. Most healthcare resource indicators were not significantly associated with composite adherence, although physician:nurse ratio showed a borderline positive association (β = 0.018 per 0.1 increase, 95% CI, -0.0004 to 0.036). Secondary prevention adherence was positively associated with health expenditure (β = 0.007; 95% CI, 0.0003-0.014). For thrombolysis within 4.5 hours, physician:nurse ratio was negatively associated (β = -0.062; 95% CI, -0.119 to -0.006), whereas nurse:bed ratio was positively associated (β = 1.232; 95% CI, 0.066-2.397). In contrast, healthcare resource indicators were not clearly associated with in-hospital outcomes.

Healthcare resource configuration showed modest associations with stroke management but limited associations with in-hospital outcomes, suggesting that resource availability alone may not fully explain variation in stroke outcomes.