Journal of Neurology

, Volume 258, Issue 11, pp 1929–1932 | Cite as

From the stroke unit to the stroke competence center: corresponding beneficial clinical and financial effects

  • A. ChatzikonstantinouEmail author
  • A. Förster
  • M. G. Hennerici
  • H. Bäzner
Original Communication


The introduction of the diagnosis related groups (DRG) system in Germany has radically influenced the organization of in-hospital patient treatment. Case-mix-index and duration of treatment in a stroke unit (SU) play a central role. Our SU started in 1998 and was gradually extended to the current “Stroke Competence Center” (SCC), with a total capacity of 29 patients. The SCC combines acute treatment, work-up and post-stroke management by the same specialized team. We aimed primarily at demonstrating the financial effects of this concept. Data from stroke patients treated in our SU/SCC between 2004 and 2009 were analyzed. We analyzed the number of treated stroke patients, number of thrombolytic treatments, the number of cases coded with procedure codes OPS 8-981.x and the ratio of OPS 8-981.0 (24–72 h on SU) to the higher remunerated OPS 8-981.1 (>72 h on SU). The number of treated patients increased by 118.3% (from 469 in 2004 to 1024 in 2009). The number of thrombolyses per year has more than quadrupled (2004: 46, 2009: 253, i.e. 25% of SU patients). The introduction of the stroke center concept lead to a great increase in the ratio of the higher rewarded OPS 8-981.1 to OPS 8-981.0 (from 1.5 in 2005 to 5.21 in 2009). Our data demonstrates that the SCC concept leads to a greater financial potential, while offering considerable medical advantages concerning more effective stroke treatment and work-up as well as improved flow of information and enhanced individual patient-physician relationship.


Stroke Unit Stroke management Diagnosis related groups 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ellinger K, Koch C, Daffertshofer M, Behrens S, Luiz T (1999) Das Mannheimer Schlaganfallprojekt. Eine Initiative zur Optimierung der Versorgungsstrategie. Notfall & Rettungsmedizin 2:428–433CrossRefGoogle Scholar
  2. 2.
    Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O’Connor R, Cawley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Walker MD (2005) Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke 36(7):1597–1616PubMedCrossRefGoogle Scholar
  3. 3.
    Diez-Tejedor E, Fuentes B (2001) Acute care in stroke: do stroke units make the difference? Cerebrovasc Dis 11(Suppl 1):31–39PubMedCrossRefGoogle Scholar
  4. 4.
    Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley ECJ, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774PubMedCrossRefGoogle Scholar
  5. 5.
    Perez de la Ossa N, Millan M, Arenillas JF, Sanchez-Ojanguren J, Palomeras E, Dorado L, Guerrero C, Davalos A (2009) Influence of direct admission to Comprehensive Stroke Centers on the outcome of acute stroke patients treated with intravenous thrombolysis. J Neurol 256(8):1270–1276Google Scholar
  6. 6.
    Roger France FH (2003) Case mix use in 25 countries: a migration success but international comparisons failure. Int J Med Inform 70(2–3):215–219PubMedCrossRefGoogle Scholar
  7. 7.
    Epstein D, Mason A, Manca A (2008) The hospital costs of care for stroke in nine European countries. Health Econ 17(Suppl 1):S21–S31PubMedCrossRefGoogle Scholar
  8. 8.
    Leal J, Luengo-Fernandez R, Gray A, Petersen S, Rayner M (2006) Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J 27(13):1610–1619PubMedCrossRefGoogle Scholar
  9. 9.
    Hacke W, Brott T, Caplan L, Meier D, Fieschi C, von Kummer R, Donnan G, Heiss WD, Wahlgren NG, Spranger M, Boysen G, Marler JR (1999) Thrombolysis in acute ischemic stroke: controlled trials and clinical experience. Neurology 53(7 Suppl 4):S3–S14PubMedGoogle Scholar
  10. 10.
    Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359(13):1317–1329PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • A. Chatzikonstantinou
    • 1
    Email author
  • A. Förster
    • 1
  • M. G. Hennerici
    • 1
  • H. Bäzner
    • 1
  1. 1.Department of NeurologyUniversitäsMedizin Mannheim, University of HeidelbergMannheimGermany

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