Utilisation of diagnostic computerised tomography imaging and immediate clinical outcomes in older people with stroke before and after introduction of the National Service Framework for older people. A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience

Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute ho...

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Published in:Age and ageing 2006-07, Vol.35 (4), p.399-403
Main Authors: Myint, Phyo K., Vowler, Sarah L., Redmayne, Oliver, Fulcher, Robert A.
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged patients
Aged, 80 and over
Clinical outcomes
Comparative studies
Computerized
Diagnosis
elderly
Elderly patients
Elderly people
England
Female
Health aspects
Health care
Humans
Inpatient care
Length of Stay
Male
Middle Aged
Mortality
Multivariate Analysis
National service
NSF
Older people
Prejudice
Recovery of Function
Registries
Retrospective Studies
State Medicine - standards
State Medicine - trends
Stroke
Stroke (Disease)
Stroke - complications
Stroke - diagnosis
Stroke - mortality
Strokes
Tomography
Tomography, X-Ray Computed - utilization
Treatment Outcome
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description Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF. Methods: two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: 65-year olds, suggesting better clinical outcome in those who survived. Conclusions: in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. Continual monitoring using stroke registry data may help to assess whether these effects are sustained in the longer term.
doi_str_mv 10.1093/ageing/afl030
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A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience</title><source>Applied Social Sciences Index &amp; Abstracts (ASSIA)</source><source>Oxford Journals Online</source><creator>Myint, Phyo K. ; Vowler, Sarah L. ; Redmayne, Oliver ; Fulcher, Robert A.</creator><creatorcontrib>Myint, Phyo K. ; Vowler, Sarah L. ; Redmayne, Oliver ; Fulcher, Robert A.</creatorcontrib><description>Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF. Methods: two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: &lt;65, 65–84 and ≥85 years of age. Annual summary data for these periods were compared for the magnitude of changes in all age categories for all outcomes measured between pre- and post-NSF periods. Results: n = 5,219. Utilisation of CT imaging had increased in all age groups post-NSF, with the most significant improvement in the oldest group. This change was associated with a greater proportion of people who had CT in this age group being discharged home in the post-NSF period. There was no change in the mortality from stroke in any age group during the study. Although the length of acute hospital stay increased, this was associated with a higher percentage of home discharges particularly in &gt;65-year olds, suggesting better clinical outcome in those who survived. Conclusions: in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. Continual monitoring using stroke registry data may help to assess whether these effects are sustained in the longer term.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afl030</identifier><identifier>PMID: 16788080</identifier><identifier>CODEN: AANGAH</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Age Factors ; Aged ; Aged patients ; Aged, 80 and over ; Clinical outcomes ; Comparative studies ; Computerized ; Diagnosis ; elderly ; Elderly patients ; Elderly people ; England ; Female ; Health aspects ; Health care ; Humans ; Inpatient care ; Length of Stay ; Male ; Middle Aged ; Mortality ; Multivariate Analysis ; National service ; NSF ; Older people ; Prejudice ; Recovery of Function ; Registries ; Retrospective Studies ; State Medicine - standards ; State Medicine - trends ; Stroke ; Stroke (Disease) ; Stroke - complications ; Stroke - diagnosis ; Stroke - mortality ; Strokes ; Tomography ; Tomography, X-Ray Computed - utilization ; Treatment Outcome</subject><ispartof>Age and ageing, 2006-07, Vol.35 (4), p.399-403</ispartof><rights>Copyright Oxford University Press(England) Jul 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-c589e118e398407be91d99da6d98f0df9c68cea5100fe69a0af6b314e99469703</citedby><cites>FETCH-LOGICAL-c464t-c589e118e398407be91d99da6d98f0df9c68cea5100fe69a0af6b314e99469703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,30999,31000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16788080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Myint, Phyo K.</creatorcontrib><creatorcontrib>Vowler, Sarah L.</creatorcontrib><creatorcontrib>Redmayne, Oliver</creatorcontrib><creatorcontrib>Fulcher, Robert A.</creatorcontrib><title>Utilisation of diagnostic computerised tomography imaging and immediate clinical outcomes in older people with stroke before and after introduction of the National Service Framework for older people. A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF. Methods: two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: &lt;65, 65–84 and ≥85 years of age. Annual summary data for these periods were compared for the magnitude of changes in all age categories for all outcomes measured between pre- and post-NSF periods. Results: n = 5,219. Utilisation of CT imaging had increased in all age groups post-NSF, with the most significant improvement in the oldest group. This change was associated with a greater proportion of people who had CT in this age group being discharged home in the post-NSF period. There was no change in the mortality from stroke in any age group during the study. Although the length of acute hospital stay increased, this was associated with a higher percentage of home discharges particularly in &gt;65-year olds, suggesting better clinical outcome in those who survived. Conclusions: in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. 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A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2006-07</date><risdate>2006</risdate><volume>35</volume><issue>4</issue><spage>399</spage><epage>403</epage><pages>399-403</pages><issn>0002-0729</issn><eissn>1468-2834</eissn><coden>AANGAH</coden><abstract>Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF. Methods: two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: &lt;65, 65–84 and ≥85 years of age. Annual summary data for these periods were compared for the magnitude of changes in all age categories for all outcomes measured between pre- and post-NSF periods. Results: n = 5,219. Utilisation of CT imaging had increased in all age groups post-NSF, with the most significant improvement in the oldest group. This change was associated with a greater proportion of people who had CT in this age group being discharged home in the post-NSF period. There was no change in the mortality from stroke in any age group during the study. Although the length of acute hospital stay increased, this was associated with a higher percentage of home discharges particularly in &gt;65-year olds, suggesting better clinical outcome in those who survived. Conclusions: in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. Continual monitoring using stroke registry data may help to assess whether these effects are sustained in the longer term.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>16788080</pmid><doi>10.1093/ageing/afl030</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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source Applied Social Sciences Index & Abstracts (ASSIA); Oxford Journals Online
subjects Age Factors
Aged
Aged patients
Aged, 80 and over
Clinical outcomes
Comparative studies
Computerized
Diagnosis
elderly
Elderly patients
Elderly people
England
Female
Health aspects
Health care
Humans
Inpatient care
Length of Stay
Male
Middle Aged
Mortality
Multivariate Analysis
National service
NSF
Older people
Prejudice
Recovery of Function
Registries
Retrospective Studies
State Medicine - standards
State Medicine - trends
Stroke
Stroke (Disease)
Stroke - complications
Stroke - diagnosis
Stroke - mortality
Strokes
Tomography
Tomography, X-Ray Computed - utilization
Treatment Outcome
title Utilisation of diagnostic computerised tomography imaging and immediate clinical outcomes in older people with stroke before and after introduction of the National Service Framework for older people. A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience
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