Selective Admission into Stroke Unit and Patient Outcomes: A Tale of Four Cities

Health Economics Review, 4(1), 1-10, 2014

17 Pages Posted: 4 Jul 2015

See all articles by Farasat A. S. Bokhari

Farasat A. S. Bokhari

University of East Anglia (UEA) - School of Economic and Social Studies; University of East Anglia (UEA) - Centre for Competition Policy

Ian Wellwood

Kings College London - Department of Primary Care and Public Health Science

Anthony Rudd

Kings College London - Department of Primary Care and Public Health Science

Peter Langhorne

University of Glasgow

Martin Dennis

Western General Hospital Edinburgh

Charles Wolfe

King's College London

Date Written: January 6, 2014

Abstract

Care of stroke patients costs considerably more in specialized stroke units (SU) compared to care in general medical wards (GMW) but the technology may be cost effective if it leads to significantly improved outcomes. While randomized control trials show better outcomes for stroke patients admitted to SU, observational studies report mixed findings. In this paper we use individual level data from first-ever stroke patients in four European cities and find evidence of selection by the initial severity of stroke into SU in some cities. In these cases, the impact of admission to SU on outcomes is overestimated by multivariate logit models even after controlling for case-mix. However, when the imbalance in patient characteristics and severity of stroke by admission to SU and GMW is adjusted using propensity score methods, the differences in outcomes are no longer statistically significant in most cases. Our analysis explains why earlier studies using observational data have found mixed results on the benefits of admission to SU.

Keywords: Stroke unit care; selection bias; outcomes; propensity score matching

JEL Classification: O33, I10, C21

Suggested Citation

Bokhari, Farasat A. S. and Wellwood, Ian and Rudd, Anthony and Langhorne, Peter and Dennis, Martin and Wolfe, Charles, Selective Admission into Stroke Unit and Patient Outcomes: A Tale of Four Cities (January 6, 2014). Health Economics Review, 4(1), 1-10, 2014. Available at SSRN: https://ssrn.com/abstract=2625063

Farasat A. S. Bokhari (Contact Author)

University of East Anglia (UEA) - School of Economic and Social Studies ( email )

Norwich, Norfolk NR4 7TJ
United Kingdom

University of East Anglia (UEA) - Centre for Competition Policy ( email )

UEA
Norwich Research Park
Norwich, Norfolk NR47TJ
United Kingdom

Ian Wellwood

Kings College London - Department of Primary Care and Public Health Science ( email )

5th Floor Capital House
42 Weston Street
London, SE1 3QD
United Kingdom

Anthony Rudd

Kings College London - Department of Primary Care and Public Health Science ( email )

5th Floor Capital House
42 Weston Street
London, SE1 3QD
United Kingdom

Peter Langhorne

University of Glasgow ( email )

Adam Smith Business School
Glasgow, Scotland G12 8LE
United Kingdom

Martin Dennis

Western General Hospital Edinburgh ( email )

United Kingdom

Charles Wolfe

King's College London ( email )

Strand
London, England WC2R 2LS
United Kingdom

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