Comparison of Patient-centered Outcome Measures of the International Consortium for Health Outcomes Measurements (ICHOM) Between Private and Public Healthcare System in Brazil

Introduction: An international experts panel was assembled to create a standard set of outcome measures for use in both low and high-income countries. Additionally, the panel intended to represent the most relevant outcomes for subsequent cost-effectiveness analysis. For implementing the tool, it was necessary to make it feasible in different healthcare systems. The objective of this study was to implement and compare the ICHOM outcome measures between two different stroke centers: a university public hospital and a private hospital. Methods: the medical data of all patients with stroke diagnosis consecutively admitted in the two hospitals were registered. ICHOM outcomes in the 3-month follow-up were measured by interviews in person, by phone or by e-mail, and the results were compared between the hospitals. Results: 90-day outcome measurements were available for 328 patients (169 in the private hospital and 159 in the public), corresponding to 87% of the patients admitted with stroke diagnosis in these hospitals. The mean age was 68 years in the private vs. 65 in the public, with a mean NIHSS of 7, and 90% had ischemic strokes (18% received IV thrombolysis in the private setting vs. 16% in the public). Public hospital inpatients had a greater number of comorbidities. The mortality rate was 14% in both hospitals, and functional independence (mRS 0-2) occurred in 51% of private setting patients and 39% of the public. The greater proportion of patients needing help for dressing or toileting, as well as having language issues, was in the public setting. Better outcomes were measured in the private hospital regarding the resumption of the social role (64% vs 40%), satisfaction with social activities (65% vs 57%) and good quality of life (66% vs 57%). In both hospitals, 34% had access to physiotherapy after hospital discharge. Conclusions: In patients with acute stroke from private and public hospitals the thrombolysis eligibility are similar, without increasing the mortality rates in the public setting. However, better functional outcomes were found in private patients, probably due to less comorbidities, better prevention and post-discharge rehabilitation care.