Utilisation of diagnostic computerised tomography imaging and immediate clinical outcomes in older people with stroke before and after introduction of the National Service Framework for older people. A comparative study of hospital-based stroke registry data (1997–2003): Norfolk experience
1 Department of Medicine for the Elderly, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
2 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
3 Department of Public Health and Primary Care, Centre for Applied Medical Statistics, University of Cambridge, Robinson Way, Cambridge CB2 2SR, UK
Address correspondence to: P. K. Myint, Clinical Gerontology Unit, Level 2 F&G Block, Box-251, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK. Tel: (+44) 1223 217292. Fax: (+44) 1223 336928. Email: pkyawmyint{at}aol.com
Introduction: how the National Service Framework (NSF) for older people in England might be associated with changes in clinically relevant stroke outcome has not been investigated. We looked for changes in computerised tomography (CT) scan rate, inpatient case-fatality rate (CFR), length of acute hospital stay and discharge destination for older people with stroke, compared with their younger counterparts, for a period before, and after, the introduction of the NSF.
Methods: two periods, 4 years before and 2 years after the publication of the NSF, were selected to compare the above outcomes between three age categories: <65, 65–84 and 
85 years of age. Annual summary data for these periods were compared for the magnitude of changes in all age categories for all outcomes measured between pre- and post-NSF periods.
Results: n = 5,219. Utilisation of CT imaging had increased in all age groups post-NSF, with the most significant improvement in the oldest group. This change was associated with a greater proportion of people who had CT in this age group being discharged home in the post-NSF period. There was no change in the mortality from stroke in any age group during the study. Although the length of acute hospital stay increased, this was associated with a higher percentage of home discharges particularly in >65-year olds, suggesting better clinical outcome in those who survived.
Conclusions: in this single-centre analysis, the post-NSF period appeared to be associated with improvement in outcome in older people with stroke. Continual monitoring using stroke registry data may help to assess whether these effects are sustained in the longer term.
Keywords: NSF, stroke, older people, elderly