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Costs of Stroke Care in the VHA

Reker DM, Duncan PW, Horner RD, Hoenig HM, Samsa GP, Jia H, Vogel WB. Costs of Stroke Care in the VHA. Paper presented at: VA HSR&D National Meeting; 2003 Feb 13; Washington, DC.




Abstract:

Objectives: The objectives of this research, using DSS intermediate product level data, are to: 1) identify the departmental level services and costs provided in the acute care setting and post acute care setting for stroke patients receiving all their care in the VHA, and 2) assess the associations of costs with independent 'process' and patient 'outcome' measures. Methods: A prospective cohort of 288 patients with acute stroke (WHO definition) in 11 VAMC sites were enrolled, evaluated at baseline, followed through their post-acute rehabilitation through medical chart review, and evaluated at 6 months post stroke by a blinded follow-up interviewing organization. Line level DSS data from outpatient and inpatient services were obtained and cleaned on all patients throughout the period of study (from stroke onset to 6 months post stroke). Process of care measures were collected through chart review and were based on compliance with published AHRQ stroke care guidelines. Outcome measures at 6 months post stroke consisted of FIM motor scores, IADL scores, patient satisfaction, and quality of life (SF-36V and Stroke Impact Scale). Results: Of the 288 patient cohort, 31 (11%) patients did not receive their acute or post-acute care in the VA and 39 (14%) had missing or invalid data and were dropped from the final cost dataset. Acute care inpatient costs totaled $2.1M. The greatest departmental costs were borne by: hospital (20%), nursing (13%), radiology (10%), neurology (9%), and medicine (8%). Post acute inpatient costs totaled $1.5M. The greatest departmental cost in the post acute treatment were: physical medicine and rehab (26%), hospital (23%), nursing (17%), medicine (12%), and pharmacy (5%). The average cost per day of inpatient care was $938 (acute) and $689 (post acute). Outpatient costs totaled $1M with 85% of cost occurring during the follow-up period from post acute discharge to 6 months post stroke. Post acute inpatient costs are significantly related to guideline compliance r = 0.28 p = .002 but not directly to patient outcomes. Conclusions: Resource use affects guideline compliance which in turn affects patient outcomes. Impact: VA facilities that cut resources for post acute rehabilitation are likely affecting patient outcomes indirectly through reduced services.





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