Abstract WP386: Improving Statewide Stroke Systems of Care in Times of Fiscal Challenge - the Results of Effective Partnership
Backgrd: Stroke has afflicted ~7 M Americans. Total cost is ~ $43B per year. Treatment is poorly accessed due to geopolitical and resource challenges especially at Critical Access Hospitals. The Affordable Care Act of 2010, will ensure more Americans have access. Are stroke state systems of care adequately prepared to provide high quality care, and if so at what cost?
Object/Meth: To develop an equitable statewide stroke system of care based on ASA-BAC guidelines, by executing an inclusive, legislative-supported Stroke System Task Force. The VSSTF was sanctioned in 2007 by the Va Joint Comm. of Healthcare; 30+ voluntary members were selected to represent each part of the continuum of care. Key stakeholders included experts from health insurance, pharma, hospital administration, with regional representation; meetings were held quarterly. Key partners included VDH, ASA, all major academic institutions, Va Hospital & Healthcare Assoc. All inpatient stroke data from pre and post VSSTF activities (2007-11) were analyzed by a Public Health consultant (DH) using a CMS required database (Va Health Information).
Results: From 2007-11, the number of PSCs increased ~500% (7 to 34), with 1 PSC for every ~230K people (7/52 state ranking). There was a 50% increase in use of t-PA in admitted patients. Telestroke existed in 1 hospital in 2007, and in 18 hospitals in 2011. ~28% of patients were treated in a PSC in ’07, compared to 70% in ‘11. LOS fell by 1 day; the avg charge/case increased by 23%. Total ischemic stroke charges grew by 73%. Inpatient mortality was flat with a 75% increase in hospice transfers.
Conclusions: There was a correlation between establishing a well-partnered, regionally diverse Stroke Task Force, and increased number of PSCs, higher % of pts treated at a PSC, more cases of acute TPA tx, and gowth of telestroke. External system changes, including better CMS reimbursement for TPA (2006); state legislation for reimbursement of telemedicine (2010) and EMS preferential triage to PSCs (VSSTF advocated), were also critical. Charges for care also significantly increased. The future challenge will be restraining costs as stroke cases increase, and aggressively advocating for prevention by expanding partnerships with cardiac, diabetes, home care state stakeholders.
- © 2012 by American Heart Association, Inc.