Elsevier

Health Policy

Volume 119, Issue 8, August 2015, Pages 1005-1010
Health Policy

Health reform monitor
Centralising acute stroke care and moving care to the community in a Danish health region: Challenges in implementing a stroke care reform

https://doi.org/10.1016/j.healthpol.2015.05.007Get rights and content
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open access

Highlights

  • Analysis of implementation of stroke care reform including hospital and municipal care sector.

  • Reform concentrated acute stroke care and moved rehabilitation care to the community.

  • Costs were saved and quality of acute care improved.

  • Top-down approach to implementation does not secure a coordinated care pathway.

Abstract

In May 2012, one of Denmark's five health care regions mandated a reform of stroke care. The purpose of the reform was to save costs, while at the same time improving quality of care. It included (1) centralisation of acute stroke treatment at specialised hospitals, (2) a reduced length of hospital stay, and (3) a shift from inpatient rehabilitation programmes to community-based rehabilitation programmes. Patients would benefit from a more integrated care pathway between hospital and municipality, being supported by early discharge teams at hospitals.

A formal policy tool, consisting of a health care agreement between the region and municipalities, was used to implement the changes. The implementation was carried out in a top-down manner by a committee, in which the hospital sector – organised by regions – was better represented than the primary care sector—organised by municipalities. The idea of centralisation of acute care was supported by all stakeholders, but municipalities opposed the hospital-based early discharge teams as they perceived this to be interfering with their core tasks. Municipalities would have liked more influence on the design of the reform.

Preliminary data suggest good quality of acute care. Cost savings have been achieved in the region by means of closure of beds and a reduction of hospital length of stay. The realisation of the objective of achieving integrated rehabilitation care between hospitals and municipalities has been less successful. It is likely that greater involvement of municipalities in the design phase and better representation of health care professionals in all phases would have led to more successful implementation of the reform.

Keywords

Denmark
Health care reform
Stroke care
Implementation
Centralisation
Moving care to the community
Integrated care

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Open Access for this article is made possible by a collaboration between Health Policy and The European Observatory on Health Systems and Policies.