Acute ischemic stroke and transient ischemic attack: A costly business and a strategy to reduce costs (the “Time-Zero” plan)

Gorelick, Philip B.

doi:10.1016/s1052-3057(10)80078-3

Cited by 8 publications

(2 citation statements)

References 24 publications

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“…23,24 Stroke management involves the expertise of several disciplines, which can result in poor coordination or inefficiencies in patient treatment. 25,26 This can be avoided by the use of ICP methodology, which ensures that important areas of treatment are not overlooked and unnecessary delays are prevented by timely intervention. 5,6,9 However, the success of ICP management seen in previous "before and after" studies 13,14,27,28 is not supported by randomized controlled trial data.…”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

Sulch

Perez

Melbourn

et al. 2000

Stroke

120

150

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Background and Purpose-Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay. Methods-An ICP for stroke rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (nϭ76) or conventional multidisciplinary care (nϭ76). Results-The age, sex, premorbid functional ability, and stroke characteristics of the 2 groups were comparable. There were no differences in mortality rates (10

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Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

Sulch

Perez

Melbourn

et al. 2000

Stroke

120

150

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“…In the original BAC publication on recommendations for the establishment of primary stroke centers, a similar argument was made that costs might be recouped by shortening length of stay for hospitalized stroke patients and by reducing complications associated with stroke 79. Length of hospital stay is considered one of the major drivers of costs associated with stroke and other inpatient medical care 80. Reduction of length of hospital stay and rehospitalizations has heightened importance based on the new US healthcare system plan for reimbursement and cost savings.…”

Section: Introductionmentioning

confidence: 99%

Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria

Gorelick

2013

J Stroke

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In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.

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National and International Quality Initiatives to Improve Stroke Care

Fedder

2008

Neurologic Clinics

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Acute ischemic stroke and transient ischemic attack: A costly business and a strategy to reduce costs (the “Time-Zero” plan)

Cited by 8 publications

References 24 publications

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria

National and International Quality Initiatives to Improve Stroke Care

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