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Direct costs of patients with stroke can be continuously monitored on a national level: performance, effectiveness, and Costs of Treatment episodes in Stroke (PERFECT Stroke) Database in Finland.

https://arctichealth.org/en/permalink/ahliterature134915
Source
Stroke. 2011 Jul;42(7):2007-12
Publication Type
Article
Date
Jul-2011
Author
Atte Meretoja
Markku Kaste
Risto O Roine
Merja Juntunen
Miika Linna
Matti Hillbom
Reijo Marttila
Terttu Erilä
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Source
Stroke. 2011 Jul;42(7):2007-12
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebral Hemorrhage - economics
Databases, Factual
Economics, Medical
Female
Finland
Health Care Costs
Humans
Inpatients
Male
Middle Aged
Outpatients
Registries
Stroke - economics - therapy
Subarachnoid Hemorrhage - economics
Abstract
Treatment of stroke consumes a significant portion of all healthcare expenditure. We developed a system for monitoring costs from individual patient data on a national level in Finland.
Multiple national administrative registers were linked to gain episode-of-care data on all hospital-treated patients with incident stroke over the years 1999 to 2007 (n = 94,316). Inpatient and specialist outpatient costs were evaluated with a cost database, long-term care costs with fixed prices, and medication costs with true retail prices.
For the patients of Year 2007, the mean 1-year costs after an ischemic stroke were $29 580, after an intracerebral hemorrhage $36,220, and after a subarachnoid hemorrhage $42,570, valued in Year 2008 U.S. dollars. Only part of these costs are attributable to stroke, because the annual costs prior to stroke were significant, $8900 before ischemic stroke, $7600 before intracerebral hemorrhage, and $4200 before subarachnoid hemorrhage. Older patients with ischemic stroke, and, among patients with ischemic stroke and subarachnoid hemorrhage, women, incurred higher costs. The mean estimated lifetime costs were $130,000 after ischemic stroke or intracerebral hemorrhage and $80,000 after subarachnoid hemorrhage. Annually $1.6 billion is spent in the care of Finnish patients with stroke, which equals to 7% of the national healthcare expenditure, or 0.6% of the gross domestic product. Costs of patients with stroke are increasing with prolonged survival and the aging population.
Treatment of patients with stroke is a large national investment. Setting up a nationwide system for continuous monitoring of stroke costs is feasible. Cost data should optimally be evaluated in conjunction with effectiveness and performance indicators.
PubMed ID
21527757 View in PubMed
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Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland.

https://arctichealth.org/en/permalink/ahliterature144184
Source
Stroke. 2010 Jun;41(6):1102-7
Publication Type
Article
Date
Jun-2010
Author
Atte Meretoja
Risto O Roine
Markku Kaste
Miika Linna
Susanna Roine
Merja Juntunen
Terttu Erilä
Matti Hillbom
Reijo Marttila
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
Source
Stroke. 2010 Jun;41(6):1102-7
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Disease-Free Survival
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Registries
Retrospective Studies
Stroke - mortality - therapy
Abstract
Previous studies show better outcomes for patients with stroke receiving care in stroke units, but many different stroke unit criteria have been published. In this study, we explored whether stroke centers fulfilling standardized Brain Attack Coalition criteria produce better patient outcomes than hospitals without stroke centers.
We did an observational register-linkage study of all patients with ischemic stroke treated in Finland between 1999 and 2006. After exclusion of recurrent strokes and nonanalyzable patients, we included 61 685 consecutive patients treated in 333 hospitals classified in national audits either as Comprehensive Stroke Centers, Primary Stroke Centers, or General Hospitals according to Brain Attack Coalition criteria. Primary outcome measures were case-fatality and being in institutional care 1 year after stroke.
Care in stroke centers was associated with lower 1-year case-fatality and reduced institutional care compared with General Hospitals. The number-needed-to-treat to prevent 1 death or institutional care at 1 year was 29 for Comprehensive Stroke Centers and 40 for Primary Stroke Centers versus General Hospitals. Patients treated in stroke centers had lower mortality during the entire follow-up of up to 9 years and their median survival was increased by 1 year.
This study shows a clear association between the level of acute stroke care and patient outcome and supports use of published criteria for primary and comprehensive stroke centers.
PubMed ID
20395609 View in PubMed
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Stroke monitoring on a national level: PERFECT Stroke, a comprehensive, registry-linkage stroke database in Finland.

https://arctichealth.org/en/permalink/ahliterature141223
Source
Stroke. 2010 Oct;41(10):2239-46
Publication Type
Article
Date
Oct-2010
Author
Atte Meretoja
Risto O Roine
Markku Kaste
Miika Linna
Merja Juntunen
Terttu Erilä
Matti Hillbom
Reijo Marttila
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, PO Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi.
Source
Stroke. 2010 Oct;41(10):2239-46
Date
Oct-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Databases, Factual
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Population Surveillance
Recurrence
Registries
Stroke - epidemiology
Abstract
Stroke databases are established to systematically evaluate both the treatment and outcome of stroke patients and the structure and processes of stroke services. Comprehensive data collection on this common disease is resource-intensive, and national stroke databases often include only patients from selected hospitals. Here we describe an alternative national stroke database.
We established a nationwide stroke database with multiple administrative registry linkages at the individual-patient level. Information on comorbidities; treatments before, during, and after stroke; living status; recurrences; case fatality; and costs were collected for each hospital-treated stroke patient.
The current database includes 94 316 patients with incident stroke between January 1999 and December 2007, with follow-up until December 2008. Annually, 10 500 new patients are being added. One-year recurrence was 13% and case fatality was 27% during the study period. In 2007, 86% of patients survived 1 month and 77% were living at home at 3 months, but the proportion treated in stroke centers (62%) or with nationally recommended secondary preventive medication after ischemic stroke (49%) was still suboptimal.
In comparison with other national stroke databases, our method enables higher coverage and more thorough follow-up of patients. Information on long-term recurrences, case fatality, or costs is not often included in national stroke databases. Our database has low maintenance costs, but it lacks detailed data on in-hospital processes. Use of national administrative data, where such linkage is possible, saves resources, achieves high rates of long-term follow-up, and allows for comprehensive monitoring of the burden of the disease.
PubMed ID
20798363 View in PubMed
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Trends in treatment and outcome of stroke patients in Finland from 1999 to 2007. PERFECT Stroke, a nationwide register study.

https://arctichealth.org/en/permalink/ahliterature133897
Source
Ann Med. 2011 Jun;43 Suppl 1:S22-30
Publication Type
Article
Date
Jun-2011
Author
Atte Meretoja
Markku Kaste
Risto O Roine
Merja Juntunen
Miika Linna
Matti Hillbom
Reijo Marttila
Terttu Erilä
Aimo Rissanen
Juhani Sivenius
Unto Häkkinen
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. atte.meretoja@fi mnet.fi
Source
Ann Med. 2011 Jun;43 Suppl 1:S22-30
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Female
Finland - epidemiology
Humans
Length of Stay - statistics & numerical data
Male
Outcome and Process Assessment (Health Care) - economics - statistics & numerical data
Registries - statistics & numerical data
Stroke - economics - epidemiology - therapy
Abstract
This article in this supplement issue on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT) project describes trends in Finnish stroke treatment and outcome.
The PERFECT Stroke study uses multiple national registry linkages at individual patient level to produce a national stroke database with comprehensive follow-up of all hospital-treated stroke patients in Finland.
There were 94,316 incident stroke patients treated in Finnish hospitals from 1999 to 2007. Lengths-of-stays decreased after ischemic stroke (IS), and increased after intracerebral (ICH) and subarachnoid (SAH) hemorrhage. Ten-year survival improved in IS (hazard ratio 0.75; 95% CI 0.71-0.79) and ICH patients (0.88; 0.79-0.97), increasing median survival by 2 and 1 life-years respectively. This has translated into more days spent home among IS patients, but not among ICH patients. Treatment by neurologists improved the survival of IS (odds ratio [OR] 1.77; 95% CI 1.70-1.84) and ICH patients (OR 1.55; 95% CI 1.40-1.69), and treatment by neurosurgeons of SAH patients (OR 2.66; 95% CI 2.25-3.16), the effects were further improved by care in specialized stroke centers.
The survival of Finnish IS and ICH patients has improved. Specialized acute care was associated with improved outcome.
PubMed ID
21639714 View in PubMed
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