Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge

Saka, Ö; Serra, Victoria; Samyshkin, Yevgeniy; McGuire, Alistair; Wolfe, Charles

doi:10.1161/strokeaha.108.518043

Cited by 88 publications

(66 citation statements)

References 33 publications

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“…For example, the treatment of stroke patients in dedicated stroke units has been recommended by European and American guidelines for the management of stroke patients [26,27]. However, treatment in a stroke unit is more expensive than treatment on a general medical ward [28,29]. At the time of our study, these extra costs were not adequately reimbursed in the majority of countries, as the treatment of patients within the setting of a stroke unit was taken into account only by the DRG systems in Austria, Germany and Poland.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Peltola

Quentin²

2013

Cerebrovasc Dis

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Background: Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. Methods: National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. Results: European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries’ systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Conclusions: Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries’ DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Peltola

Quentin²

2013

Cerebrovasc Dis

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“…A few trials [25][26][27] have documented that ESD is a cost-effective alterna- tive to usual care, and a systematic review concludes with "moderate evidence" that ESD provides care at lower total costs than usual care. 28 There are several methodological challenges in this area.…”

Section: Discussionmentioning

confidence: 99%

Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Fjærtoft

Rohweder

Indredavik

2011

Stroke

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Background and Purpose-Early supported discharge (ESD) seems to be a promising alternative to conventional follow-up care after acute stroke. We have previously shown that stroke unit care combined with ESD has beneficial effects on functional outcome and the use of resources for up to 1 year. The aim of this trial was to evaluate outcome after 5 years. Methods-We performed a randomized controlled trial with 320 acute stroke patients allocated to ordinary stroke unit care (160 patients) or stroke unit care with ESD (160 patients). The ESD service consisted of a mobile team that co-coordinated hospital discharge and further rehabilitation during 1 month of follow-up in cooperation with the primary health care. Mortality, residence, and functional outcome including modified Rankin scale were registered after 5 years. All assessments were blinded. Results-There was no difference between the groups with modified Rankin scale score Յ2 (Pϭ0.213), but there was a trend toward greater improvement in modified Rankin scale score in the ESD group from onset of stroke (38% versus 30%; Pϭ0.106). More patients were dead or institutionalized in the ordinary stroke unit care group (Pϭ0.032); 158 patients were alive, 84 were in ESD, and 74 were in ordinary stroke unit care. Of the 158 patients alive, a greater proportion were living at home in ESD (86%/70%; Pϭ0.019). Conclusions-Stroke unit care combined with ESD seems to reduce death and institutional care and to improve patients' chances of living at home 5 years after stroke compared to traditional stroke care. There is a trend toward improved functional outcome in the ESD group. (Stroke. 2011;42:1707-1711.)

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“…Моделирование экономической эффективности с использованием данных из реестра South London Stroke Register провели в Великобритании, изучая стоимость лечения в отделениях инсульта с после-дующей ранней поддержкой после выписки (РППВ) по сравнению с лечением в отделениях инсульта без РППВ и лечением в отделениях общего профиля без РППВ [14]. При использовании порога рента-бельности в 30 тыс.…”

Section: стоимость лечения инсультаunclassified

Advances in Health Policy and Outcomes 2009

Williams

Rudd

2010

Stroke

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Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge

Cited by 88 publications

References 33 publications

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

Stroke Unit Care Combined With Early Supported Discharge Improves 5-Year Outcome

Advances in Health Policy and Outcomes 2009

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