Effect of a stroke protocol on hospital costs of stroke patients

Bowen, James; Yaste, Caroline

doi:10.1212/wnl.44.10.1961

Cited by 103 publications

(57 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Implemented in 34% of hospitals according to a recent survey, 27 clinical pathways have been found to reduce hospital charges, LOS, and complication rates. 5,6,16,17,28,29 A recent prospective randomized trial of a clinical pathway in stroke rehabilitation units failed to show a difference in mortality or LOS. 4 The authors suggested that implementation of a clinical pathway may not be beneficial when care has been previously well coordinated.…”

Section: Discussionmentioning

confidence: 99%

“…2 Other studies have shown that more systematic stroke care improves efficiency, but few have evaluated mortality or functional outcomes. [3][4][5][6] The BAC recognized the importance of outcome-based research to establish the efficacy of stroke centers. 1 In an attempt to evaluate the elements of stroke centers recommended by the BAC, we examined their effects on ischemic stroke outcomes in a cohort of patients admitted to academic medical centers throughout the United States.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum

2001

Stroke

View full text Add to dashboard Cite

Background and Purpose-Data supporting the efficacy of stroke center characteristics are limited. Methods-A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium. In-hospital mortality of all emergency department admissions for ischemic stroke at these institutions was evaluated in a database of discharge abstracts during 1997-1999. Institutional characteristics were evaluated as predictors of in-hospital mortality after adjustment for age, sex, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Length of stay (LOS), total hospital charges, and frequency of tissue plasminogen activator (tPA) administration were evaluated as secondary outcomes. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Results-Thirty-two institutions completed the questionnaire, and 29 of these were included in the database of discharge abstracts. In-hospital deaths occurred in 758 (7.0%) of the 10 880 ischemic stroke patients admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum

2001

Stroke

View full text Add to dashboard Cite

show abstract

“…For example, treatment by an organized team, 11 and the use of stroke-care maps 12,13 have been associated with shorter hospital stays, fewer complications, and improved functional outcome. As expected ( Table 2), hospitals that provided full basic or advanced stroke prevention and treatment services more commonly had rapid stroke patient identification programs, stroke teams, stroke-care maps, and stroke acute unit care units (or their equivalents).…”

Section: Discussionmentioning

confidence: 99%

“…Organization of care may also affect outcome after stroke. Management by neurologists, 9,10 treatment by an organized team, 11 and the use of stroke-care maps 12,13 have been associated with shorter hospital stays, fewer complications, and improved functional outcome.…”

mentioning

confidence: 99%

North Carolina Stroke Prevention and Treatment Facilities Survey

Goldstein

Hey

Laney

2000

Stroke

View full text Add to dashboard Cite

Background/Purpose-The aim of this study was to determine the statewide availability of facilities and programs for stroke prevention and treatment to identify underserved regions and target educational efforts. Methods-A single-page survey was mailed to the directors of each inpatient medical facility in North Carolina. Data collected included the availability of selected diagnostic tests, programs, and services. Facilities were categorized as providing basic (emergency department, brain CT, treatment with rtPA, transthoracic echocardiography, carotid ultrasonography, cerebral angiography, carotid endarterectomy) or advanced (basic services plus brain MRI, MR angiography, transesophageal echocardiography, transcranial Doppler ultrasonography, interventional radiology) services. The availability of other programs and services, including having a neurologist on staff, organized anticoagulation clinics, inpatient rehabilitative services, diffusion-weighted MRI, community awareness and rapid stroke identification programs, stroke teams, stroke acute care units or an equivalent, and the use of stroke-care maps, were also determined. Results-Complete responses were obtained from all of the state's 125 inpatient medical facilities. Overall, 97% of the state's population resided in counties with a hospital providing at least some stroke prevention or treatment procedures or services. Full basic services were provided by 23 facilities located in 19 of the state's 100 counties and were available to 52% of the state's population based on county of residence; advanced services were provided by 8 facilities located in 7 counties and were available to 26% of the state's population based on county of residence. Stroke-care maps were used in 83% of basic or advanced centers versus 23% of other hospitals (PϽ0.001), stroke teams were organized in 48% versus 12% (Pϭ0.001), stroke units or equivalents were available in 61% versus 9% (PϽ0.001), rapid patient identification programs were in place in 57% versus 9% (PϽ0.001), and community awareness programs were in place in 57% versus 21% (Pϭ0.005). Conclusions-Only 52% of the state's population reside in counties with hospitals providing full basic services; by expanding these services to only 6 additional facilities and thereby encompassing the state's 50 most populous counties, this proportion would be increased to 84%. Services that may improve outcomes and reduce costs (eg, stroke teams, stroke units, care maps) are not widely used, even in centers with full basic capabilities. Targeting educational efforts to these centers could improve the overall level of stroke care for the majority of the state's population. The study serves as a model that can be applied to other states and regions. (Stroke. 2000;31:66-70.)

show abstract

“…Clinical and neurological evaluation scales assist in the standardization of the monitoring process and prognostic estimate of the cases. The treatment of stroke patients accompanied by a neurologist seems to improve the diagnostic and prognostic accuracy for these patients [43][44][45][46][47][48][49][50][51][52][53] . It is fundamental to consider the possibility of differential diagnoses.…”

Section: Stroke In the Emergency Departmentmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part I

Oliveira‐Filho

Martins

Pontes-Neto

et al. 2012

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

These guidelines are a result of several meetings from the Brazilian Stroke Society (Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV, website www.sbdcv.org.br), which represents the Scientific Department in cerebrovascular diseases of the Brazilian Academy of Neurology, responsible for technical opinions and educational projects related to cerebrovascular diseases. Members from SBDCV participated in web-based discussion forum with pre-defined themes, followed by a formal onsite meeting in which controversies and final position statements were discussed. Finally, a writing group was created to revise and translate the final document, which was approved by all members of the SBDCV. The final text aims to guide specialists and non-specialists in stroke care in managing patients with acute ischemic stroke. The hemorrhagic stroke guideline has been previously published by the same group 1 . In the final recommendations, Oxford classification for evidence level and recommendation grade was used: EVIDENCE LEVELS1. Randomized controlled clinical trial (RCT) or systematic review (SR) of RCT with clinical endpoints. 2. RCT or SR of lower quality: with substitute, validated endpoints; with subgroup analysis or with a posteriori hypotheses; with clinical endpoints, but with methodological flaws.3. RCT with substitute, non-validated endpoints case-control studies. 4. Study with clinical endpoint, but with a higher potential bias (as in experiment without comparison group and other observational studies). 5. Representative forum or expert opinion without abovementioned evidence. RECOMMENDATION GRADESA Systematic review (homogeneous) of RCT; or single RCT with narrow confidence interval; or therapeutic results of "all or nothing" type. B Systematic review (homogeneous) of cohort studies; or cohort study and RCT of lower quality; or outcomes research or ecological study; or systematic review (homogeneous) of case-control studies; or case-control study. C Case reports (including cohort or case-control study of lower quality). D Expert opinion without critical evaluation, based on physiological or animal studies.In this first part of the guidelines, specific topics included were: epidemiology, stroke as a medical emergency, education, pre-hospital management, emergency management, neuroimaging and laboratory evaluation. A translated version of these guidelines in Portuguese is available in the Society's webpage (www.sbdcv.org.br).

show abstract

Effect of a stroke protocol on hospital costs of stroke patients

Abstract: There were significant savings in hospitalization cost for patients with acute stroke after introduction of a treatment protocol. These savings were almost entirely related to decreased length of stay. The protocol led to modest differences in tests ordered and treatments provided.

Cited by 103 publications

References 0 publications

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

North Carolina Stroke Prevention and Treatment Facilities Survey

Guidelines for acute ischemic stroke treatment: part I

Contact Info

Product

Resources

About