Changes in hospital care for strokes in acute care and in follow-up care and rehabilitation between 2007 and 2009 in France

Objectives > The objectives of this study are to describe the characteristics and recent trends in hospital care for transient ischemic attacks (TIAs) and strokes based on data from the national databases of the Medical Information Systems Program (PMSI). It describes changes that occurred between 2007 and 2009 in acute care and in follow-up care and rehabilitation (SSR). Methods > Acute care hospitalizations were selected from the PMSI "medicine, surgery, obstetrics, and dentistry" (PMSI MCO) databases based on the primary diagnosis of TIA or stroke. For the study of the SSR pathway, patients who had been hospitalized for a stroke during a short-stay admission were subsequently identified in the PMSISSR databases using an anonymization number. Results > In 2009, the total number of short-stay hospitalizations was 138,601: 31,674 for TIA and 106,927 for stroke, with 91% of cases treated in the public sector. The average length of stay was 6.4 days for TIA and 12.7 days for stroke. Over two years, hospitalizations for stroke in neurovascular units (NVUs) increased from 9.7% to 25.9%, and the proportion of stays in a facility with a neurovascular unit (NVU) rose from 22.9% to 47.4%. The proportion of surviving patients transferred to follow-up care or rehabilitation after a stroke was 33.8% in 2009: 10.4% were in functional rehabilitation and 23.4% in medical follow-up care, compared to 7.5% and 24.2%, respectively, in 2007. Discussion > The PMSI allows for the reliable tracking of short-stay hospitalizations and SSR admissions. It is a comprehensive data source that provides a national overview of hospitalizations. However, the information collected in these databases depends on the quality of variable coding, particularly for those describing care in acute care units (ACUs). It is therefore likely that the proportion of stroke patients treated in ACUs is somewhat underestimated. Conclusion > National hospitalization databases show an improvement in stroke care between 2007 and 2009. In short-term care, there was a sharp increase in hospitalizations in acute care units and, concurrently, in healthcare facilities with acute care units. Regarding the follow-up care and rehabilitation sector, there was an increase of more than one-third in the rate of transfer to functional rehabilitation following a stroke. (R.A)

Author(s): de Peretti C, Nicolau J, Tuppin P, Schnitzler J, Woimant F

Publishing year: 2012

Pages: 491-503

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