Methodological issues in monitoring health services and outcomes for stroke survivors: A case study

published online 08 January 2010.
Corrected Proof

Abstract

Background

Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the National Institutes of Health and the Istituto Superiore di Sanità (its Italian equivalent) to foster collaborative research on rehabilitation.

Objective

The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany.

Methods

This study used qualitative and quantitative methods to study health resources available to and used by stroke survivors during the first 12 months poststroke in two Italian health authorities (AUSLs 10 and 11). Mortality rates were used as an outcome measure.

Results

Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared with AUSL 11. There was no significant difference between mortality rates.

Conclusion

Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.

Keywords: Stroke, Outcomes, Equity, Administrative data

a Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, MD 21250, USA

b Department of Veterans Affairs, Baltimore, MD 21201, USA

c Agenzia Sanitaria Regionale, Regione Emilia-Romagna 40127, Italy

d Dipartmento della Riabilitazione, Azienda Unità Sanitaria Locale 11, Regione Oscana, Empoli 50053, Italy

e Direzione Generale, Azienda Ospedaliera Universitaria Senese, Regione Toscana, Siena 53100, Italy

f Direzione Sanitaria, Azienda Unità Sanitaria Locale 11, Regione Toscana, Empoli 50053, Italy

g Istituto Superiore di Sanità, Rome 00161, Italy

h Department of Health, Nutrition, and Exercise Sciences, University of Delaware, Newark, DE 19716, USA

i Departments of Neurology and Medicine, Division of Gerontology, University of Maryland, Baltimore, MD 21201, USA

j National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA

Corresponding author: 1000 Hilltop Circle.

Financial disclosures: None of the authors has any financial competing interests. Drs. Papini, Benvenuti, and Roccato and Mr. Nerattini are employed by Health Authorities in Italy. We want to acknowledge the support of Alessandro Reggiani, Azienda Unità Sanitaria Locale 11, Regione Toscana, and Dr. Carlo Tomassini (previously at Azienda Unità Sanitaria Locale 10 in Florence), Aziende Ospedaliera Universitaria Senese, Siena, Italy, who provided administrative support for this study. This study was financially supported in part by the Azienda Unità Sanitaria Locale 10 and 11, Regione Toscana, and Istituto Superiore di Sanità, Roma, Italy, within the project “Obtaining Optimally Functional Recovery and Efficient Managed Care for the Chronic Stroke Population” (convenzione N. 530/F20/2). Independent observers were provided by the Baltimore Veterans Administration GRECC, Stroke REAP, Exercise and Robotics Center of Excellence, and the University of Maryland, Baltimore County. We thank the John E. Fogarty International Center and the National Center for Medical Rehabilitation Research at NICHD for providing travel support. The following individuals reviewed data from the stroke pilot study and made recommendations regarding future enhancements: Douglas Bradham, Ph.D., Division of Healthcare Outcomes Research, Department of Preventive Medicine and Epidemiology, University of Maryland Medical School; Donald Steinwachs, Ph.D., Director of the Health Services Research and Development Center, Johns Hopkins Bloomberg School of Hygiene and Public Health; Alex Dromerick, M.D., National Rehabilitation Hospital, Washington, DC; Andrew Kramer, M.D., Division of Health Care Policy and Research, Department of Medicine, University of Colorado Health Sciences Center; and Pamela Duncan, Ph.D., Director of Research, Division of Physical Therapy, Duke University.

PII: S1936-6574(09)00196-4

doi:10.1016/j.dhjo.2009.11.003