Study objective-To assess the impact of guidelines for stroke management on the utilisation of services by patients and the cost consequences of implementation.
Setting-District health authority in southern England Patients-A total of 468 live non-comatose stroke patients registered between Nov-ember 1991 and May 1993.
Main outcome measures-A comparison between the three, six month periods for investigations performed and rehabilita-tion received and their associated costs.
The appropriateness of the use of investigations improved over time to between 88 and 92% except for computed tomography (CT) (24%). Younger, more severely impaired patients in a medical bed were more likely to have CT.
Overall levels of rehabilitation were low.
There was no change in use of physiotherapy (61% to 63%), a significant increase in occupational therapy (26% to 39%) and a non significant change in speech therapy (34% to 25%) over time.
Guideline introduction caused a modest £23 increase in costs per patient in the 2nd six months and £41 in the 3rd six months but this sum could rise to £430 per patient if full implementation of the guidelines occurred which is still only around 13% of the costs of nursing care while in hospital.
Conclusions-This 18 month audit shows only modest changes in practice compared with guidelines, and overall levels of rehabilitation were low. (...)
Mots-clés Pascal : Accident cérébrovasculaire, Recommandation, Service santé, Utilisation, Analyse coût, Homme, Angleterre, Grande Bretagne, Royaume Uni, Europe, Economie santé, Organisation santé, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Stroke, Recommendation, Health service, Use, Cost analysis, Human, England, Great Britain, United Kingdom, Europe, Health economy, Public health organization, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0515352
Code Inist : 002B17C. Création : 13/02/1998.