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Abstract
Background One of the biggest challenges we face in health care is minimizing variations in care across the continuum. Vizient created a national collaborative focused on stroke which identified leading strategies in reducing variations in stroke care system-wide. According to the Centers for Disease Control and Prevention, each year more than 795,000 people in the United States have a stroke; and health system’s direct medical costs are projected to reach $94.3 billion by 2035. In terms of market impact, stroke and neurovascular disease represent a significant portion of inpatient volumes and source of growth- representing 34% of US market discharges in 2018.
Objectives In 2019, fifty organizations comprised of large academic medical centers, community health and critical access hospitals participated in Vizient’s Stroke Collaborative to network with peers across the nation to learn leading strategies and share improvement information. Leading subject matter experts shared knowledge and discussed current standards of stroke care, identified innovative ways to improve care transitions and assessed care settings to optimize delivery of patient care across the continuum.
Methods May – October 2019. Two distinct cohorts were developed for primary stroke and comprehensive stroke centers who met bi-monthly for education, coaching and networking opportunities. Collaborative Requirements: Complete project charter, monthly progress updates, baseline and remeasure data submissions.
Results Over a 6 month time period, collaborative participants measured 30-day readmissions to measure improvement across two time periods. 56% reduced readmission rates for Ischemic Stroke performance and 47% reduced readmission rates for Hemorrhagic Stroke performance.
Stroke volumes and disease burden in the US from Sg2 analytics
Notes (figure 1): Analysis excludes 0–17 age group and includes the neurosciences and spine service lines and the Brain/Central Nervous System (CNS) Cancer CARE Family from the cancer service line. CNS injury includes concussion, late effects of neuro trauma, paralysis, skull fracture and major brain injury, and spinal cord injury. Movement disorders include Parkinson disease, movement disorders, multiple sclerosis and demyelinating diseases. Neuro pain disorders include headache/migraine, neuro pain and neuropathy. Other includes hydrocephalus and spina bifida, neurologic disease—other, and sleep disorders. Stroke and neurovascular include ischemic and hemorrhagic stroke, transient ischemic attack, and neurovascular diseases. Sources: Impact of Change®, 2018; HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 2015. Agency for Healthcare Research and Quality, Rockville, MD; Claritas Pop-Facts®, 2018; Circulation. 2019;139:e56–e528. DOI: 10.1161/CIR.0000000000000659; Sg2 Analysis, 2018.
Ischemic stroke performance
Notes (figure 2): n=32. Ischemic Stroke ICD 10 Codes. Hemorrhagic Stroke ICD 10 codes. Evaluated 30 day unplanned, all cause all payer readmission rates (adults, 18 years and older). Comparisons amongst facilities is not advised since a select number of facilities met the exclusion criteria. Exclusion criteria: total discharges for at least one period was equal or less than 20 discharges. Considerations for interpreting results: volume fluctuations did occur by hospital type (primary stroke centers vs. comprehensive stroke centers), which may impact the% difference when calculating readmissions. Source: Vizient Clinical Data Base/Resource Manager™
Hemorrhagic stroke performance
Notes (figure 3): N=19. Ischemic Stroke ICD 10 Codes. Hemorrhagic Stroke ICD 10 codes. Evaluated 30 day unplanned, all cause all payer readmission rates (adults, 18 years and older). Comparisons amongst facilities is not advised since a select number of facilities met the exclusion criteria. Exclusion criteria: total discharges for at least one period was equal or less than 10 discharges. Considerations for interpreting results: volume fluctuations did occur by hospital type (primary stroke centers vs. comprehensive stroke centers), which may impact the% difference when calculating readmissions. Source: Vizient Clinical Data Base/Resource Manager™
Conclusions Key learnings for success were prioritized to reduce clinical variations in care for stroke patients and optimize system-wide transitions in care (figure 4). This collaborative model effectively identified best practices to reduce variations in stroke care while preparing for emerging advancements in technology, guidelines and new care delivery payment models.
Key learnings for success