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

Author

Listed:
  • Rocco Friebel
  • Katharina Hauck
  • Paul Aylin
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.

Suggested Citation

  • Rocco Friebel & Katharina Hauck & Paul Aylin, 2018. "Centralisation of acute stroke services in London: Impact evaluation using two treatment groups," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 722-732, April.
    • Handle: RePEc:wly:hlthec:v:27:y:2018:i:4:p:722-732
    DOI: 10.1002/hec.3630
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    References listed on IDEAS

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    1. Friebel, Rocco & Fisher, Rebecca & Deeny, Sarah R. & Gardner, Tim & Molloy, Aoife & Steventon, Adam, 2019. "The implications of high bed occupancy rates on readmission rates in England: A longitudinal study," Health Policy, Elsevier, vol. 123(8), pages 765-772.
    2. Elizabeth Ann Laird & Claire McCauley & Assumpta Ryan & Alison Beattie, 2020. "‘The Lynchpin of the Acute Stroke Service’—An envisioning of the scope and role of the advanced nurse practitioner in stroke care in a qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(23-24), pages 4795-4805, December.
    3. Huguet, Marius, 2020. "Centralization of care in high volume hospitals and inequalities in access to care," Social Science & Medicine, Elsevier, vol. 260(C).
    4. Friebel, Rocco & Juarez, Rosa M., 2020. "Spill Over Effects of Inpatient Bed Capacity on Accident and Emergency Performance in England," Health Policy, Elsevier, vol. 124(11), pages 1182-1191.

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