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Open Access Study protocol

Evaluation of stroke services in Anglia stroke clinical network to examine the variation in acute services and stroke outcomes

Phyo K Myint12*, John F Potter12, Gill M Price1, Garry R Barton1, Anthony K Metcalf2, Rachel Hale2, Genevieve Dalton3, Stanley D Musgrave1, Abraham George4, Raj Shekhar5, Peter Owusu-Agyei6, Kevin Walsh7, Joseph Ngeh8, Anne Nicholson9, Diana J Day10, Elizabeth A Warburton10 and Max O Bachmann1

Author Affiliations

1 Norwich Medical School, Faculty of Medicine & Health Sciences, Norwich, UK

2 Norfolk & Norwich University Hospital, Norwich, UK

3 Anglia Stroke & Heart Clinical Network, Cambridge, UK

4 James Paget University Hospital, Lowestoft, UK

5 Queen Elizabeth Hospital, King's Lynn, UK

6 Peterborough City Hospital, Peterborough, UK

7 Hinchingbrooke Hospital, Huntingdon, UK

8 Ipswich Hospital, Ipswich, UK

9 West Suffolk Hospital, Bury St Edmund, UK

10 Addenbrooke's University Hospital, Cambridge, UK

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BMC Health Services Research 2011, 11:50  doi:10.1186/1472-6963-11-50

Published: 28 February 2011

Abstract

Background

Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors.

Methods/Design

We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses.

Discussion

This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.