Resource use and costs of Ischemic Stroke in a Managed Care Setting
Members of the Greater Cincinnati/Northern Kentucky Stroke Team retrospectively examined administrative claims data for a pilot study of 12-month survivors of acute ischemic stroke from a locally based managed care program. New ischemic stroke cases were identified between November 1997-July 1998 and defined by an absence of a primary ICD9 code for a TIA or ischemic stroke during the preceding 10–12 months. The managed care organization provided all inpatient hospital, outpatient hospital, ambulatory care and prescription claims for 12 months prior to and after the new case. Cases (n=54) averaged 56.1 years of age, 61.1% males and all survived the 1st year past stroke. Predominant comorbidities included: hypertension (50%), diabetes (24.1%), hypercholesterolemia (33.3%), ischemic heart disease (24.1%), and chronic respiratory illness (20.4%). Total health care costs increased by 244% from the period prior to the stroke. Stroke-related costs increased over 6-fold while non-stroke costs increased by 46%. We compared the resources utilized in the period after the ischemic stroke event to the AHA Stroke Council’s 1994 Guidelines for the Management of Acute Ischemic Stroke and 1997 AHA Practice Guidelines for Use of Imaging. This comparison was made to determine if the managed care enrollees received evaluations, treatments and services directed towards preventing recurrent strokes and maximizing patient outcome. An analysis of specific components of care delivered will be provided.