From Tupelo Neurology Clinic (S.D.N.), North Mississippi Health System
(J.E., K.M.D.), and North Mississippi Medical Center (A.B.-T., K.E.K.),
Tupelo, Miss.
Correspondence to Janet Englert, RN, Clinical Efficiency Department, North Mississippi Medical Center, 830 S Gloster St, Tupelo, MS 38801. E-mail jenglert{at}nmhs.net
Background and
Purpose—Ischemic stroke is a high-volume and financially
draining diagnosis at this rural health system. The purpose of this
clinical practice analysis was to identify resource utilization
and clinical process inefficiencies and to promote clinically
efficient, evidence-based improvements.
Methods—A retrospective analysis of medical record
and financial databases of 356 patients with ischemic stroke
was performed. The medical record data were adjusted for severity,
and outliers were eliminated. The resources utilized by each physician
were determined. Comparative graphs were prepared, presented,
and discussed. The physicians implemented two types of changes: (1)
alteration of resource utilization and consultation patterns and (2)
support of clinical process improvement. In 1997, a follow-up
analysis of 399 patients was performed.
Results—The initial comparison of internists' to neurologists'
patient populations found the following: patient age (75 versus 65
years), patient severity ratings (2.8 versus 2.5), length of stay (10.7
versus 8.8 days), costs ($7360 versus $6862), mortality rates (12.5%
versus 8.9%), and aspiration pneumonia rate (8.5% versus 3.8%). A
comparison of the 1995 analysis to the 1997 analysis
revealed the following per patient resource utilization decreases (all
P<0.05): chemistry laboratory, 2.65 to 1.95 studies;
intravenous fluids, 2.85 to 1.85 L; oxygen use, 6.06 to
2.75 U; and nifedipine use, 1.62 to 0.33 capsules. The
clinical process improvements resulted in the following overall
outcomes (all P<0.05 except mortality): length of stay
(7.2 days), nonadjusted costs ($6246), mortality (6.5%), and rates of
pneumonia (2.7%).
Conclusions—Objective analysis of resource utilization
resulted in physicians changing their individual management of stroke
and collectively supporting clinical process changes that improved
clinical and financial outcomes.
© 1998 American Heart Association, Inc.
Original Contributions
Clinical Efficiency Tools Improve Stroke Management in a Rural Southern Health System
Key Words: cost and cost analysis • quality of health care • stroke management
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