Comparison of the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage between Canada and the United States

Henry A. Glick, Daniel E. Polsky, Richard J. Willke, Wayne M. Alves, Neal Kassell, Kevin Schulman

Research output: Contribution to journalArticle

Abstract

Objective - Using data from a randomized trial of tirilazad mesylate, we assessed the differences between Canada and the United States in the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage during the first 90 days after admission to the hospital. Methods - Of the 877 patients for whom economic data were available, 194 were enrolled in Canada and 683 were enrolled in the United States. The differences between the countries in patient characteristics, use of medical resources, and outcomes were analyzed by comparing means and the 95% confidence intervals (CIs) around the differences in means. These differences also were predicted with use of multivariable regression analysis. Results - The average hospital stay was 4.2 days longer (95% CI, 1.3 to 7.1 days) in Canada, but most of the extra stay was among patients admitted to the study in poor neurological condition. In general, however, hospital stays in Canada were substantially less intensive. Patients treated in Canada spent 3.7 fewer days (95% CI, 1.2 to 6.1 days) in nursing homes and rehabilitation centers than did patients in the United States. No statistically significant differences were seen for Glasgow Outcome Scale score, death, and occurrence of vasospasm. Conclusions - For patients admitted to the study in good neurological condition, the apparent difference in length of stay between Canada and the United States was caused by a shift in the sites of formal care rather than to the length of this care. For those admitted in poor neurological condition, both the length and sites of care differed between the two countries. No significant difference in outcomes appeared to justify these differences in the use of medical resources.

Original languageEnglish (US)
Pages (from-to)351-358
Number of pages8
JournalStroke
Volume29
Issue number2
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

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Subarachnoid Hemorrhage
Canada
Length of Stay
Confidence Intervals
Glasgow Outcome Scale
Rehabilitation Centers
Nursing Homes
General Hospitals
Regression Analysis
Economics

Keywords

  • Canada
  • Lipid peroxidation
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Comparison of the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage between Canada and the United States. / Glick, Henry A.; Polsky, Daniel E.; Willke, Richard J.; Alves, Wayne M.; Kassell, Neal; Schulman, Kevin.

In: Stroke, Vol. 29, No. 2, 01.01.1998, p. 351-358.

Research output: Contribution to journalArticle

Glick, Henry A. ; Polsky, Daniel E. ; Willke, Richard J. ; Alves, Wayne M. ; Kassell, Neal ; Schulman, Kevin. / Comparison of the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage between Canada and the United States. In: Stroke. 1998 ; Vol. 29, No. 2. pp. 351-358.
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