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International Journal of Health Economics and Management

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03.11.2021 | Research Article

The weekend effect in stroke mortality: evidence from Austrian acute care hospitals

verfasst von: Florian Bachner, Martin Zuba

Erschienen in: International Journal of Health Economics and Management | Ausgabe 2/2022

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Abstract

Many studies provide evidence for the so-called weekend effect by demonstrating that patients admitted to hospital during weekends show less favourable outcomes such as increased mortality, compared with similar patients admitted during weekdays. The underlying causes for this phenomenon are still discussed controversially. We analysed factors influencing weekend effects in inpatient care for acute stroke in Austria. The study analysed secondary datasets from all 130 public acute care hospitals in Austria between 2010 and 2014 (Austrian DRG Data). The study cohort included 86,399 patient cases admitted with acute ischaemic stroke. By applying multivariate regression analysis, we tested whether patient, treatment or hospital characteristics drove in-hospital mortality on weekends and national holidays. We found that the risk to die after an admission at weekend was significantly higher compared to weekdays, while the number of admissions following stroke was significantly lower. Adjustment for patient, treatment and hospital characteristics substantially reduced the weekend effect in mortality but did not eliminate it. We conclude that the observed weekend effect could be explained either by lower quality of health care or higher severity of stroke admissions at the weekend. In depth analyses supported the hypothesis of higher stroke severity in weekend patients as seen in other studies. While DRG data is useful to analyse stroke treatment and outcomes, adjustment for case mix and severity is essential.

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Data on the time that elapses between initial stroke and recurrence are sparse. An Asian study reported an average time interval between first ever and recurrent ischemic stroke of 58,75 months (Zhu et al., 2016). Another German study shows a mean time interval of 697 days (Stahmeyer et al., 2019). We see higher frequencies of patients following the assumed initial stroke for a time period of about 6 months with very short stays or ambulatory care in the dataset. These stays are usually coded as acute stroke due to the absence of a code for follow up care after stroke.

Note, this data cannot be matched on an individual basis to the DRG data set.

Angerer, S., Buttinger, K., & Stummer, H. (2019). The weekend effect revisited: Evidence from the Upper Austrian stroke registry. The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care, 20(5), 729–737. https://doi.org/10.1007/s10198-019-01035-4CrossRefPubMed

Arulprakash, N., & Umaiorubahan, M. (2018). Causes of delayed arrival with acute ischemic stroke beyond the window period of thrombolysis. Journal of Family Medicine and Primary Care, 7(6), 1248–1252. https://doi.org/10.4103/jfmpc.jfmpc_122_18CrossRefPubMedPubMedCentral

Becker, D. J. (2007). Do hospitals provide lower quality care on weekends? Health Services Research, 42(4), 1589–1612. https://doi.org/10.1111/j.1475-6773.2006.00663.xCrossRefPubMedPubMedCentral

Bell, C. M., & Redelmeier, D. A. (2001). Mortality among patients admitted to hospitals on weekends as compared with weekdays. The New England Journal of Medicine, 345(9), 663–668. https://doi.org/10.1056/NEJMsa003376CrossRefPubMed

Bray, B. D., Ayis, S., Campbell, J., Cloud, G. C., James, M., Hoffman, A., Tyrrell, P. J., Wolfe, C. D., & Rudd, A. G. (2014). Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: Prospective multicentre cohort study. PLoS Medicine, 11(8), e1001705. https://doi.org/10.1371/journal.pmed.1001705CrossRefPubMedPubMedCentral

Bray, B. D., Cloud, G. C., James, M. A., Hemingway, H., Paley, L., Stewart, K., Tyrrell, P. J., Wolfe, C. D., & Rudd, A. G. (2016). Weekly variation in health-care quality by day and time of admission: A nationwide, registry-based, prospective cohort study of acute stroke care. Lancet (london, England), 388(10040), 170–177. https://doi.org/10.1016/s0140-6736(16)30443-3CrossRef

Bray, B. D., & Steventon, A. (2017). What have we learnt after 15 years of research into the “weekend effect”? BMJ Quality & Safety, 26(8), 607–610. https://doi.org/10.1136/bmjqs-2016-005793CrossRef

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.CrossRef

Clarke, J., Davidson, M. M., Ferris, J. A. J., Gardner, P. S., Gillie, I. M. S., Hogg, M., Longstaff, L., Mantle, D., Ranasinghe, H., Riley, P., Robinson, M. C., Sanderson, A. Y., Scott, D. J., Scott, W. A., Sims, D. G., Warnasuriya, N. D., Webb, J. K. G., & Wilson, D. L. (1977). Newcastle survey of deaths in early childhood 1974/76, with special reference to sudden unexpected deaths. Working party for early childhood deaths in Newcastle. Archives of Disease in Childhood, 52(11), 828–835.CrossRef

Eurostat (2016). RAMON - Reference And Management Of Nomenclatures, Degree of Urbanisation (DEGURBA) - Local Administrative Units. In. European Commission, Brussels.

Ferro, J.M., Bousser, M.G., Canhao, P., Coutinho, J.M., Crassard, I., Dentali, F., di Minno, M., Maino, A., Martinelli, I., Masuhr, F., Aguiar de Sousa, D. (2017). European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. 24(10), 1203–1213. doi:https://doi.org/10.1111/ene.13381

Freemantle, N., Richardson, M., Wood, J., Ray, D., Khosla, S., Shahian, D., Roche, W. R., Stephens, I., Keogh, B., & Pagano, D. (2012). Weekend hospitalization and additional risk of death: An analysis of inpatient data. Journal of the Royal Society of Medicine, 105(2), 74–84. https://doi.org/10.1258/jrsm.2012.120009CrossRefPubMedPubMedCentral

Gattringer, T., Ferrari, J., Knoflach, M., Seyfang, L., Horner, S., Niederkorn, K., Culea, V., Beitzke, M., Lang, W., Enzinger, C., & Fazekas, F. (2014). Sex-related differences of acute stroke unit care: Results from the Austrian stroke unit registry. Stroke, 45(6), 1632–1638. https://doi.org/10.1161/STROKEAHA.114.004897CrossRefPubMed

Geissler, A., Scheller-Kreinsen, D., Quentin, W., & Busse, R. (2012). DRG systems in Europe. Incentives, purposes and differences in 12 countries. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 55(5), 633–642.CrossRef

GeoMagis: Shortest distance matrix, road traffic (2016). In. GeoMarketing & GIS Solutions und Services GmbH, St. Pölten.

Ghiani, M., Mueller, S., Maywald, U., & Wilke, T. (2021). Hospitalized with stroke at the weekend: Higher cost and risk of early death? International Journal of Stroke. https://doi.org/10.1177/1747493021992597CrossRefPubMed

Hellevik, O. (2007). Linear versus logistic regression when the dependent variable is a dichotomy. Quality & Quantity, 43(1), 59–74. https://doi.org/10.1007/s11135-007-9077-3CrossRef

Hoh, B. L., Chi, Y. Y., Waters, M. F., Mocco, J., & Barker, F. G., 2nd. (2010). Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke, 41(10), 2323–2328. https://doi.org/10.1161/strokeaha.110.591081CrossRefPubMed

Hsieh, C. Y., Lin, H. J., Chen, C. H., Li, C. Y., Chiu, M. J., & Sung, S. F. (2016). “Weekend effect” on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study. Medicine, 95(25), e4046. https://doi.org/10.1097/MD.0000000000004046CrossRefPubMedPubMedCentral

Joynt, K. E., Harris, Y., Orav, E. J., & Jha, A. K. (2011). Quality of care and patient outcomes in critical access rural hospitals. The Journal of the American Medical Association, 306(1), 45–52. https://doi.org/10.1001/jama.2011.902CrossRefPubMed

KAKuG: Bundesgesetz über Krankenanstalten und Kuranstalten (1957) In, vol. BGBl Nr. 1/1957. Wien.

Kelly-Hayes, M., Wolf, P. A., Kase, C. S., Brand, F. N., McGuirk, J. M., & D’Agostino, R. B. (1995). Temporal patterns of stroke onset. The Framingham Study. Stroke, 26(8), 1343–1347. https://doi.org/10.1161/01.str.26.8.1343CrossRefPubMed

Lasserson, D. S., Chandratheva, A., Giles, M. F., Mant, D., & Rothwell, P. M. (2008). Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: Prospective population based study. British Medical Journal, 337, a1569. https://doi.org/10.1136/bmj.a1569CrossRefPubMedPubMedCentral

McKinney, J. S., Deng, Y., Kasner, S. E., & Kostis, J. B. (2011). Comprehensive stroke centers overcome the weekend versus weekday gap in stroke treatment and mortality. Stroke, 42(9), 2403–2409. https://doi.org/10.1161/strokeaha.110.612317CrossRefPubMed

Meacock, R., Doran, T., & Sutton, M. (2015). What are the costs and benefits of providing comprehensive seven-day services for emergency hospital admissions? Health Economics, 24(8), 907–912. https://doi.org/10.1002/hec.3207CrossRefPubMed

Neuraz, A., Guerin, C., Payet, C., Polazzi, S., Aubrun, F., Dailler, F., Lehot, J. J., Piriou, V., Neidecker, J., Rimmele, T., Schott, A. M., & Duclos, A. (2015). Patient mortality is associated with staff resources and workload in the ICU: A multicenter observational study. Critical Care Medicine, 43(8), 1587–1594. https://doi.org/10.1097/CCM.0000000000001015CrossRefPubMed

Ozdemir, B. A., Sinha, S., Karthikesalingam, A., Poloniecki, J. D., Pearse, R. M., Grocott, M. P., Thompson, M. M., & Holt, P. J. (2016). Mortality of emergency general surgical patients and associations with hospital structures and processes. British Journal of Anaesthesia, 116(1), 54–62. https://doi.org/10.1093/bja/aev372CrossRefPubMed

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V., & Tirschwell, D. L. (2018). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American heart association/american stroke association. Stroke, 49(3), e46–e110. https://doi.org/10.1161/str.0000000000000158CrossRefPubMed

Roberts, S. E., Thorne, K., Akbari, A., Samuel, D. G., & Williams, J. G. (2015). Mortality following stroke, the weekend effect and related factors: Record linkage study. PLoS ONE, 10(6), e0131836. https://doi.org/10.1371/journal.pone.0131836CrossRefPubMedPubMedCentral

Rost, N. S., Bottle, A., Lee, J. M., Randall, M., Middleton, S., Shaw, L., Thijs, V., Rinkel Gabriel, J. E., & Hemmen Thomas, M. (2016). Stroke severity is a crucial predictor of outcome: An international prospective validation study. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.115.002433CrossRefPubMedPubMedCentral

Saposnik, G. et al. (2007). Hospital volume and stroke outcome: Does it matter? Neurology 69(1).

Saposnik, G., Baibergenova, A., Bayer, N., & Hachinski, V. (2007). Weekends: A dangerous time for having a stroke? Stroke, 38(4), 1211–1215. https://doi.org/10.1161/01.STR.0000259622.78616.eaCrossRefPubMed

Stahmeyer, J. T., Stubenrauch, S., Geyer, S., Weissenborn, K., & Eberhard, S. (2019). The frequency and timing of recurrent stroke: An analysis of routine health insurance data. Deutsches Ärzteblatt International, 116(42), 711–717. https://doi.org/10.3238/arztebl.2019.0711CrossRefPubMed

Sung, S. F., Hsieh, C. Y., Kao Yang, Y. H., Lin, H. J., Chen, C. H., Chen, Y. W., & Hu, Y. H. (2015). Developing a stroke severity index based on administrative data was feasible using data mining techniques. Journal of Clinical Epidemiology, 68(11), 1292–1300. https://doi.org/10.1016/j.jclinepi.2015.01.009CrossRefPubMed

Svendsen Marie, L., Ehlers Lars, H., Ingeman, A., & Johnsen Søren, P. (2012). Higher stroke unit volume associated with improved quality of early stroke care and reduced length of stay. Stroke, 43(11), 3041–3045. https://doi.org/10.1161/STROKEAHA.111.645184CrossRefPubMed

Walker, A. S., Mason, A., Quan, T. P., Fawcett, N. J., Watkinson, P., Llewelyn, M., Stoesser, N., Finney, J., Davies, J., Wyllie, D. H., Crook, D. W., & Peto, T. E. A. (2017). Mortality risks associated with emergency admissions during weekends and public holidays: An analysis of electronic health records. Lancet (london, England), 390(10089), 62–72. https://doi.org/10.1016/s0140-6736(17)30782-1CrossRef

Zajic, P., Bauer, P., Rhodes, A., Moreno, R., Fellinger, T., Metnitz, B., Stavropoulou, F., Posch, M., & Metnitz, P. G. H. (2017). Weekends affect mortality risk and chance of discharge in critically ill patients: A retrospective study in the Austrian registry for intensive care. Critical Care (london, England), 21(1), 223. https://doi.org/10.1186/s13054-017-1812-0CrossRef

Zhu, R., Xu, K., Shi, J., Yan, Q. (2016). Time interval between first ever and recurrent stroke in a population hospitalized for second stroke: A retrospective study. Neurology Asia 21(3).

Titel: The weekend effect in stroke mortality: evidence from Austrian acute care hospitals
verfasst von: Florian Bachner
Martin Zuba
Publikationsdatum: 03.11.2021
Verlag: Springer US
Erschienen in: International Journal of Health Economics and Management / Ausgabe 2/2022
Print ISSN: 2199-9023
Elektronische ISSN: 2199-9031
DOI: https://doi.org/10.1007/s10754-021-09317-2

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The weekend effect in stroke mortality: evidence from Austrian acute care hospitals

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