Abstract
We examined the influence of inter-hospital cooperation between an acute stroke center and rehabilitation hospital on patient outcome and length of hospital stay. Patients with acute ischemic stroke admitted between May 1999 and April 2000 were enrolled on the study. In total, 806 patients (459 men, 347 women ; 71. 0±12.2 years old) who were admitted to hospitals in Kumamoto city where good inter-hospital cooperation ex-isted were classified as group U. On the other hand, group R (217 patients ; 140 men, 77 women ; 72.2±11.9 years old) consisted of patients who were admitted to hospitals in the suburbs of Kumamoto. The average NIHSS on admission was 8.2 for group U and 9.0 for group R. The average length of hospital stay in each group was 17.3 and 38.1 days, respectively. Patients who were directly discharged to their home (43% of group U and 55% of group R) were hospitalized for 12.5 days and 32.0 days, respectively. Their modified Rankin Scale (at discharge/one year later) was 0.8/1.4 for group U and 1.0/1.6 for group R. Similarly, patients who were transferred to other hospitals comprised 44% and 21% of groups U and R, respectively. The length of hospital stay and mRS (at discharge/one year later) in the two groups were 22.7 days and 3.7/3.8 for group U, and 65.8 days and 4.0/4.0 for group R. We have been developing a new stroke management system based on the stroke unit with referral to a rehabilitation unit at another hospital (inter-hospital referral model) in Kumamoto city. The length of hospital stay has decreased remarkably in comparison with the "intra-hospital referral model". This "regional inter-hospital referral model" is regarded as a model for acute stroke management systems.
