... and has no firm conclusion

摘要

The improvement in London and Manchester stroke services is important and has offered real clinical benefits to patients.1 However, several problems with the study of Morris and colleagues (and more broadly) limit the extent of the conclusion that increased centralisation of stroke (and other) services automatically improves clinical outcomes. Comparing services in London and Manchester with those in the rest of England, ratherthan a more suitably matched control, weakens any conclusions about the effect of centralisation. A comparison between London (and Manchester) stroke services and otherwell performing but differently configured services (measured by Stroke Sentinel National Audit Programme performance) would potentially offer more information about optimal service configuration, although heavily confounded by funding. The current comparison shows that well performing services do betterthan the average, but the effects of resources and the underlying quality of clinical services are major confounders that limit conclusions on the role of centralisation.