Evaluation of efficiency of organizational models for stroke management (stroke units)

OBJECTIVE: To describe based on the best available evidence, the current state of knowledge about the relative contribuition of the stroke organized models of care to the improvements in clinical outcomes, and to describe based on the published information, the resource use impact of the implementation of theses models, as well as its efficiency (cost-effectiveness) compared to the conventional care. METHODOLOGY: Three systematic reviews were carried out simultaneosly. Three search strategies can be described: search A (systematic reviews and health technology assesment reports with no time limit until may 2013) Search B ( randomized controlled trails from 2006 until may 2013) and Search C (articles/documents with primary data on resource use, experimental and observational studies with no time limit until may 2013) were applied to search in the following electronic databases: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (CRD Database), Health Technology Assessment Database (CRD Database), PubMed, CINHAL (EBSCO) Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, Stroke Trials Registry, WHO Clinical Trials, metaRegister of Controlled Trials (mRCT), Embase, NHS Economic Evaluation Database (CRD Database), Cost--Effectiveness Analysis Registry, Center for the Evaluation of Value and Risk in Health, Tufts University combining MESH terms and free text. Hand-searching was done using the references of the articles included in the review and in the helth technology assesment agencies websites. Articles were selected (systematic reviews, randomized and controlled clinical trials and observational studies) according to each search criteria and which compared Stroke Units with other organization alternatives. The obtained information was extracted and analysed by two reviewers independently. The heterogenity of the studies made impossible the meta-analysis, and then the presentation of the results is through qualitative synthesis besides descriptive tables of the articles included.