Article

The aim of this study was to assess regional variations of the
hospital management of stroke patients during acute and post-acute phases in
France in 2015. METHODS: Hospitalized patients coded with stroke as
their main diagnosis or, if hospitalized in several different wards, any main
ward diagnosis were identified in the 2015 French national hospital discharge
database for acute care. Rates of hospitalization in stroke units (SUs) were
assessed at a national level and in all metropolitan and overseas regions. All
stroke survivors discharged at the end of the acute phase were subsequently
identified in the national database for post-acute rehabilitation hospitalization
(PARH) within 3 months. RESULTS: In the acute phase, half the stroke patients
hospitalized for intracerebral hemorrhage, cerebral infarction or unspecified
stroke were admitted to SUs. However, there were variations across metropolitan
regions (from 30% to 69%) and in overseas regions (from 1% to 59%); these rates
correlated with regional ratios of SU beds/100,000 inhabitants. There were also
regional differences in PARH rates-in hemiplegic stroke patients, 62% were
admitted for PARH (range: 58% to 67%) in metropolitan regions and, overseas, from
8% to 67%-as well as geographical discrepancies in PARH rates to specialized
rehabilitation units. Hospitalization rates of hemiplegic stroke patients in
neurological rehabilitation centers were 30% for the whole country, but ranged
from 23% to 36% in metropolitan regions and from 2% to 45% in overseas regions.
CONCLUSION: This study focused on hospital-based management of stroke patients.
In spite of the creation of new SUs over the past decade in France, there are
persistent regional differences in the number of SU beds/100,000 inhabitants and,
consequently, in the rate of stroke patients managed in SUs. However, rates
continue to improve with the creation of new SUs and the expansion of existing
ones. Regional variations were also noted for post-acute hospitalization rates
and PARH beds/places.
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