• A G Rudd, P Irwin, Z Rutledge, D Lowe, D T Wade, and M Pearson.
• CEEU and Guy's and St Thomas' Hospital, London, UK. anthony.rudd@kcl.ac.uk
• Clin Rehabil. 2001 Oct 1; 15 (5): 562-72.

Study ObjectiveTo identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke.DesignRetrospective audit of case notes and service organization.SettingTwo hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland.PatientsThe 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit.ResultsThere are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay.ConclusionsThere were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.

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