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Centralisation of acute stroke services in London: Impact evaluation using two treatment groups

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Title: Centralisation of acute stroke services in London: Impact evaluation using two treatment groups
Authors: Friebel, R
Hauck, K
Aylin, P
Item Type: Journal Article
Abstract: The bundling of clinical expertise in centralised treatment centres is considered an effective intervention to improve quality and efficiency of acute stroke care. In 2010, 8 London Trusts were converted into Hyper Acute Stroke Units. The intention was to discontinue acute stroke services in 22 London hospitals. However, in reality, provision of services declined only gradually, and 2 years later, 15% of all patients were still treated in Trusts without a Hyper Acute Stroke Unit. This study evaluates the impact of centralising London's stroke care on 7 process and outcome indicators using a difference-in-difference analysis with two treatment groups, Hyper Acute and discontinued London Trusts, and data on all stroke patients recorded in the hospital episode statistics database from April 2006 to April 2014. The policy resulted in improved thrombolysis treatment and lower rates of pneumonia in acute units. However, 6 indicators worsened in the Trusts that were meant to discontinue services, including deaths within 7 and 30 days, readmissions, brain scan rates, and thrombolysis treatment. The reasons for these results are difficult to uncover and could be related to differences in patient complexity, data recording, or quality of care. The findings highlight that actual implementation of centralisation policies needs careful monitoring and evaluation.
Issue Date: 1-Apr-2018
Date of Acceptance: 31-Oct-2017
URI: http://hdl.handle.net/10044/1/55653
DOI: https://dx.doi.org/10.1002/hec.3630
ISSN: 1057-9230
Publisher: Wiley
Start Page: 722
End Page: 732
Journal / Book Title: Health Economics
Volume: 27
Issue: 4
Copyright Statement: © 2017 John Wiley & Sons, Ltd. This is the peer reviewed version of the following article: Friebel R, Hauck K, Aylin P. Centralisation of acute stroke services in London: Impact evaluation using two treatment groups. Health Economics. 2017;1–11, which has been published in final form at https://dx.doi.org/10.1002/hec.3630. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Sponsor/Funder: Medical Research Council (MRC)
Funder's Grant Number: MR/K010174/1B
Keywords: Social Sciences
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Business & Economics
centralisation of stroke care
difference-in-difference models
health policy evaluation
panel data analysis
14 Economics
11 Medical And Health Sciences
Publication Status: Published
Online Publication Date: 2017-12-28
Appears in Collections:Department of Surgery and Cancer