Paula Muñoz Venturelli1, Thompson Robinson2, Pablo M Lavados3, Verónica V Olavarría4, Hisatomi Arima5, Laurent Billot6, Maree L Hackett7, Joyce Y Lim6, Sandy Middleton8, Octavio Pontes-Neto9, Bin Peng10, Liying Cui10, Lily Song11, Gillian Mead12, Caroline Watkins13, Ruey-Tay Lin14, Tsong-Hai Lee15, Jeyaraj Pandian16, H Asita de Silva17, Craig S Anderson18. 1. The George Institute for Global Health, University of Sydney, Sydney, Australia; Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile. 2. Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Disease, University of Leicester, Leicester, UK. 3. Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile. 4. Unidad de Neurología Vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile. 5. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 6. The George Institute for Global Health, University of Sydney, Sydney, Australia. 7. The George Institute for Global Health, University of Sydney, Sydney, Australia; College of Health and Wellbeing, University of Central Lancashire, Preston, UK. 8. Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia. 9. Stroke Service, Neurology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil. 10. Department of Neurology, Peking Union Medical College Hospital, Beijing, China. 11. Department of Neurology, Shanghai 85th Hospital of PLA, Shanghai, China. 12. Department of Geriatric Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK. 13. College of Health and Wellbeing, University of Central Lancashire, Preston, UK; Nursing Research Institute, St Vincents Health Australia (Sydney) and Australian Catholic University, Australia. 14. Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan. 15. Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan. 16. Department of Neurology, Christian Medical College, Ludhiana, Punjab, India. 17. Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. 18. The George Institute for Global Health, University of Sydney, Sydney, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia; The George Institute, China, Peking University Health Sciences Center, Beijing, China. Electronic address: canderson@georgeinstitute.org.au.
Abstract
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS:HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS:94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
RCT Entities:
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. RESULTS: 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P<0.001), and a significantly higher proportion of acute ischemic strokepatients received intravenous thrombolysis (10 vs. 5%; P=0.002) compared to MIC hospitals. CONCLUSIONS: Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes.
Authors: Paula Muñoz Venturelli; Xian Li; Sandy Middleton; Caroline Watkins; Pablo M Lavados; Verónica V Olavarría; Alejandro Brunser; Octavio Pontes-Neto; Taiza E G Santos; Hisatomi Arima; Laurent Billot; Maree L Hackett; Lily Song; Thompson Robinson; Craig S Anderson Journal: J Am Heart Assoc Date: 2019-06-25 Impact factor: 5.501
Authors: Jay Chol Choi; Joong Goo Kim; Chul Hoo Kang; Hee Joon Bae; Jihoon Kang; Soo Joo Lee; Jong Moo Park; Tai Hwan Park; Yong Jin Cho; Kyung Bok Lee; Jun Lee; Dong Eog Kim; Jae Kwan Cha; Joon Tae Kim; Byung Chul Lee; Ji Sung Lee; Anthony S Kim Journal: J Korean Med Sci Date: 2021-03-22 Impact factor: 2.153
Authors: Paula Muñoz Venturelli; Jason P Appleton; Craig S Anderson; Philip M Bath Journal: Curr Neurol Neurosci Rep Date: 2018-09-18 Impact factor: 5.081