International Journal of Epidemiology 2002;31:880
© International Epidemiological Association 2002
Book Review |
Stroke Services. Policy and Practice across Europe.
C Wolfe, C McKevitt, A Rudd (eds). Abingdon, UK: Radcliffe Medical Press, 2002, pp.144, £24.95. ISBN: 1-85775-455-7.
This book is a wonderful example of how the sciences of epidemiology and health services research can be integrated and applied practically to the understanding and management of a major public heath problem (in this case, stroke) in a large, multicultural region of the world (in this case, Europe).
The central theme is the rationale, design, results and implications (for health care providers, planners and policy makers) of the European Union Biomed Concerted Action studies of stroke. The 23 authors of this 144-page, 9-chapter book are all collaborators in this project (geriatricians, neurologists, public health physicians, health care researchers), amongst whom Wolfe, McKevitt and Rudd are the editors and co-ordinators.
The book begins by presenting the previously published evidence for the substantial variation in outcomes of stroke (morbidity and mortality) among different countries throughout the world and asking why is this so, and particularly, why is this so in the different countries in Europe? This is the prompt to begin a study which is dedicated to documenting the outcome of stroke care in various European centres, and the likely important modifiable determinants of outcome (e.g. differences in structure and process, besides age, culture and socioeconomic status).
The second and third chapters are a marvellous account of the principles of developing a data set for the Biomed studies, and the relevance and important characteristics of population-based registers. I wish I had read such a sound and clearly written source of these principles and characteristics 15 years ago (before embarking on my own epidemiological studies) which are widely applicable to many kinds of health services research.
The next four chapters focus on measuring the structure, process and outcome (including subjective outcomes of patients) of stroke care; and how and why they may vary throughout Europe. Such factors which may influence outcome after stroke include the number of stroke patients (incidence), the type of stroke patients (incidence of stroke subtypes, prevalence of causal risk factors and prognostic factors, and co-morbidities), the interventions (access, appropriateness and quality of care), which and how outcome is measured, and the random play of chance. The potential hazards that are inherent in the interpretation of comparisons of outcomes among centres by league tables (even those that adjust for many or all of the above factors [e.g. casemix]), are highlighted appropriately.
Chapter eight outlines a method of measuring the costs of stroke care across European centres, and exploring the reasons for cost differences.
The concluding chapter is an honest and humble account of the positive and negative outcomes of the studies, the lessons learned, and the opportunities for, and areas in need of, future research.
The editors and authors of this book are to be congratulated for their insight, energy, collaboration and commitment to undertaking and fulfilling such an ambitious and important project, as described in this book. It is well designed, edited and indexed; easy to navigate; and consequently a pleasure to read. The references are up-to-date and relevant to the subject. Moreover, the methods and results are novel and will be of immediate and direct interest to the providers and planners of stroke services within and throughout Europe. However, the principles and generic tools are also highly relevant to other disciplines (e.g. stroke clinicians, public health physicians, and epidemiologists), to other diseases (particularly chronic diseases), and to other regions of the world (particularly multicultural, developed countries).
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