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Optimising service organisation for stroke patients

Govan, Lindsay J.W. (2009) Optimising service organisation for stroke patients. PhD thesis, University of Glasgow.

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Abstract

Background Stroke is the leading cause of long-term neurological disability in adults and the third most common cause of death in Britain. It is well known that in addition to the patient characteristics of age and severity, the treatment a stroke patient receives in hospital signifcantly affects outcome. The effectiveness of complex service interventions, how the benefits of these interventions are achieved and the economic impact of different types of service delivery were explored. Methods The Stroke Unit Trialists' Collaboration systematic review was updated and currently contains 31 clinical trials (6936 subjects). The aims were explored using various basic frequentist and Bayesian meta-analysis techniques as well as more complex meta-analysis ideas. These more complex ideas include: meta-regression where covariate information is incorporated into the model; and network meta-analysis where direct and indirect information is used in a mixed treatment comparisons model while also incorporating covariate information. Results Organised inpatient (stroke unit) care showed reductions in death, death or dependency and death or institutional care compared to general medical wards. Stroke unit care appears to reduce the risk of adverse outcomes through prevention and treatment of complications. Acute, comprehensive and rehabilitation stroke unit care appeared to be most effective and acute stroke unit care appeared to be the most cost-effective. However, acute followed by rehabilitation stroke unit care, if required, appears to be the most cost-effective pathway of care compared to the other pathways analysed. Discussion Future research should focus on rehabilitation, acute and comprehensive systems of inpatient care, and explore the best ways of preventing and managing specific complications. Effort should be made to make individual patient data and information on the care pathway of a stroke patient available for meta-analysis.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: statistics, meta-analysis, stroke, stroke unit, stroke outcome, complications, mixed treatment comparisons, stroke severity, stroke scales, cost-effectiveness
Subjects: R Medicine > R Medicine (General)
H Social Sciences > HA Statistics
Colleges/Schools: College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Supervisor's Name: Langhorne, Prof. Peter and Weir, Dr. Christopher J.
Date of Award: 2009
Depositing User: Miss Lindsay J. W. Govan
Unique ID: glathesis:2009-796
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 23 Jun 2009
Last Modified: 10 Dec 2012 13:26
URI: http://theses.gla.ac.uk/id/eprint/796

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