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Objective: To describe clinical outcomes and costs of patient management in acute phase using Cuban clinical practice guidelines in two health institutions in Havana. Methods: We performed a descriptive observational study, and from the axis of an economic evaluation was a description of costs and consequences. The universe was all patients admitted with stroke in two hospitals: the Teaching Surgical Hospital "Dr. Salvador Allende" and General Teaching Hospital "Comandante Manuel Fajardo" in a period of 6 months between 2010 and 2011. (n=13 and n=23, respectively). Results: For both groups the mortality was low, while the disability of patients at discharge was high according to the mean Barthel Index (40.4 for the Hospital S. Allende and 37.7 for M. Fajardo Hospital). In the Hospital Manuel Fajardo were observed total costs and institutional slightly higher than Salvador Allende Hospital, but these differences will be statistically significant. The total cost per patient was between 2300 and about 2500 pesos. The institutional cost per patient was 1400 pesos and 1700 pesos. Although the institutional cost represented between 50 and 70% of the total, expenditure per patient was high, with values between 800 and nearly 1000 Cuban pesos. In both hospitals were high institutional cost and expense budgets. No significant differences were found in the direct medical cost in either cost or emergency stroke unit. Conclusions: The management of stroke patients, on the basis of Cuban clinical practice guidelines showed favourable clinical results in terms of lethality, not so much in levels of disability at discharge, which was accompanied by increased spending for both institutional and family resources. This was accentuated by being inserted the stroke unit in the neurology ward. [ABSTRACT FROM AUTHOR]

Objective: To study the changes of stroke management in a tertiary center of Havana, after the introduction of a Stroke Unit with multidisciplinary team approach. Methods: We compare stroke patients assisted in Hermanos Ameijeiras Hospital in two separate periods characterized by different strategies of care. In the first period (2002-2003) stroke care was not specialized and multidisciplinary team does not exist, while in the second period (2006-2007), stroke care was organized, centralized in a Stroke Unit and headed by a specialized multidisciplinary team. Information collected from hospital records included date of birth and sex of patient, admission and discharge dates, discharge status, length of hospital stay, and diagnosis. Results: In the period 2002-2003, 656 stroke patients were admitted to the hospital and 598 in the period 2006-2007. In the second period there was an increment of patients with subarachnoid hemorrhage (110 to 156 patients), but a decrement of patients with cerebral hemorrhage (114 to 66 patients), and stroke of undetermined cause (91 to 13 patients). Specialized stroke care reduce hospital mortality (17.4 % to 11.0 %), the major impact was in ischemic stroke. The total duration of the hospital stay was inferior in patients managed in Stroke Unit with multidisciplinary stroke team (13.9 days), in contrast with those managed with a non-specialized approach (15.7 days), but the difference was not significant. Conclusions: Specialized stroke care increased tertiary functions of the hospital. In the new context, hospital mortality and hospital stay decreased. [ABSTRACT FROM AUTHOR]