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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 481 369 Management and economics Accreditation in stroke units of 6 European regions: one name, different realities D. Michiels1, V. Thijs2, Y. Sun3, O.S. Rasit4, D. Hemelsoet5, M. Eyssen6, D. Paulus7 University Hospitals Leuven, Leuven, BELGIUM1, University Hospitals Leuven - KU Leuven, Leuven, BELGIUM2, Deloitte, Diegem-Brussels, BELGIUM3, Deloitte, Diegem-Brussels, BEL-GIUM4, University Hospital Ghent, Ghent, BELGIUM5, Belgian Health Care Knowledge Centre, Brussels, BELGIUM6, Belgian Health Care Knowledge Centre, Brussels, BELGIUM7 Background: ESO guidelines aim to promote standardised care of high quality in Europe but the or-ganisation of acute care in stroke units (SU) largely differs between countries. This study aimed to scrutinize the accreditation or certification procedures of SU in 6 countries/regions: Scotland, Swe-den, The Netherlands, France, Germany and the “London Stroke Services” (LSS). Methods: the information was collected with standardised questionnaires (25 pages) sent by mail to 12 experts from the 6 countries/regions. The research team analyzed the answers and clarified fur-ther issues by interviews. Results: an official mandatory accreditation procedure (organized and paid by governmental agen-cies) exists in Scotland, in LSS and in France. In Germany this procedure exists (private organiza-tions) but is not mandatory. The accreditation process always implies at least site-visits and patient data review. Accreditation is renewed on a 1-, 3-, or 5-year basis. Some countries differentiate be-tween types of SU (e.g. primary, comprehensive SU). The study further listed the criteria that SU must fulfil and the indicators measured for their accreditation (structure, process and outcome). Few of them refer to outcomes e.g. mortality, complications and recurrence. Incentives to encourage bet-ter quality differ between countries: public reporting of the results of the accreditation procedure, support to poor performers, benchmarking between hospitals, financial consequences. Conclusion: this exhaustive analysis gives an overview of the accreditation procedures in selected European countries. Care of high quality relies on a common evidence base but the quality assur-ance procedures, the indicators used as well as the consequences of the measurement largely differ between the countries. The question is to know if these various accreditation procedures result in differences in patients’ outcomes. 370 Management and economics Insurance status, eligibility for care and thrombolysis for stroke. R. Briggs1, R. Ni Donacha2, O, Mahon3, G. Kavanagh4, J.A. Harbison5 Trinity College Dublin, Dublin, IRELAND1, Trinity College Dublin, Dublin, IRELAND2, St James’s Hospital, Dublin, IRELAND3, St James’s Hospital, Dublin, IRELAND4, Trinity College Dublin, Dublin, IRELAND5 Introduction: There is increasing evidence that social deprivation is associated with worse outcome following stroke. There is also some evidence from the US that presentation to hospital in time for thrombolysis differs between races, a phenomenon that could be due to socioeconomic factors. In Ireland 47% of the population pay health insurance whilst 36%, mainly elderly and poorer, people have the right to free primary care (Central Statistics office Q3 2010). Emergency care in hospital including Thrombolysis for stroke, is not paid for by insurance and is available for a nominal fee to all, regardless of insurance status. We performed a study comparing thrombolysed patients with age and gender matched controls to determine if these socioeconomic modifiers of access to medical care affected likelihood of treatment. Methods: All cases were matched with 2 non-thrombolysed subjects with ischaemic stroke admitted over the same period. Controls were randomly selected from a stroke register and matched for age and gender. Results. 45 Patients were thrombolysed (mean age 77 years, range 33-94 years) were compared with 90 con-trols (mean age 76, range 37-96 years). 18 patients had insurance versus 25 controls (40% vs. 28% p = 0.2 chi square). There was no difference in delay from symptoms to presentation between insured and non insured thrombolysed patients (65.1 versus 65.8 minutes p=0.96 t test) 27 cases had access to free primary care versus 60 controls (60% vs. 67% p = 0.6) and 3 cases and 9 controls had neither (7% vs. 10% p=0.7 Fishers exact). Conclusion. Nature of health coverage made no significant difference to likelihood of being throm-bolysed compared to controls. There was a trend for insured patients to be more likely to under-go thrombolysis despite the procedure not being renumerated perhaps suggesting a greater health awareness regarding the symptoms of stroke and the need for earlier presentation.


Karger_ESC London_2013
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