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Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries
Author(s) -
Peltola Mikko,
Seppälä Timo T.,
Malmivaara Antti,
Belicza Éva,
Numerato Dino,
Goude Fanny,
Fletcher Eilidh,
Heijink Richard
Publication year - 2015
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.3264
Subject(s) - negative binomial distribution , regional variation , demography , ordinary least squares , medicine , regression analysis , variance (accounting) , health care , mortality rate , cerebral infarction , statistics , economics , business , surgery , cardiology , mathematics , accounting , economic growth , advertising , poisson distribution , ischemia , sociology
Using patient‐level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk‐adjusted length of stay (LoS) of acute hospital care and 1‐year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional‐level factors with LoS and 1‐year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk‐adjusted regional‐level LoS in all of the countries studied. We used negative binomial regression to model the individual‐level LoS, and random intercept models and ordinary least squares regression for the regional‐level analysis of risk‐adjusted LoS, variance of LoS, 1‐year risk‐adjusted mortality and crude mortality for a period of 31–365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient‐level or regional‐level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices. Copyright © 2015 John Wiley & Sons, Ltd.