Redesigned Stroke Care for A Value Based World: Better Outcomes, Lower Spending (S49.002)
Neurology(2014)
摘要
OBJECTIVE:
The Stanford Clinical Excellence Research Center desired to redesign the delivery process for stroke prevention and care with the aim of attaining the lowest cost care to the best clinical outcomes.
BACKGROUND:
Stroke is the leading cause of disability in the U.S. with over $20 billion in direct medical spending. Biomedical advancements continue, but stroke care delivery has not kept apace.
DESIGN/METHODS:
Our systematic design method included: (1) A literature review of major guidelines, stroke care delivery methods, and cost effectiveness studies to identify the best practices and how to achieve them at the lowest cost; (2) Site visits with centers with high quality care delivered at the lowest cost; (3) Observations of patients and providers to identify their most vexing unmet needs; (4) Development of a new model using design thinking and all sources of evidence; (5) Estimation of the model’s cost-saving potential, using risk factor prevalence, stroke incidence, and costs of conditions and interventions.
RESULTS:
The high-value stroke care model: (1) Prevents strokes through maximal use of preventative medications using direct interactions between high risk patients and a team of proactive nurses and certified nursing assistants; (2) Stratifies patients who present with a TIA but low near term recurrent stroke risk to outpatient care, while patients with a non-disabling stroke will be evaluated under observation status; and (3) Delivers tPA with a globally exemplary time frame, (4) strengthened transition to community programs for those at high risk for readmissions.
Combined, cost modeling projects patient outcome improvements and and reduction in healthcare spending in cerebrovascular disease by 11%.
CONCLUSIONS:
Through a multi-source health care delivery redesign process, we developed a high-value stroke care model. We are piloting this model in various sites across the U.S. to verify its impact on clinical outcomes and net spending.
Study Supported by: Disclosure: Dr. Kalanithi has nothing to disclose. Dr. Conley has nothing to disclose. Dr. Milstein has nothing to disclose.
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