Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

Just why the fuck are you looking at costs before looking at the results of those costs? You Australians have to correct this fucking stupidity of your stroke world. 

Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia

• Dominique A. CadilhacEmail authorView ORCID ID profile,
• Helen M. Dewey,
• Sonia Denisenko,
• Christopher F. Bladin and
• Atte Meretoja

BMC Health Services Research201919:41

https://doi.org/10.1186/s12913-018-3836-9

©  The Author(s). 2019

• Received: 23 July 2017
• Accepted: 18 December 2018
• Published: 18 January 2019

Open Peer Review reports

Abstract

Background

Hospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care.(What about the results of that stroke 'care'?) Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program.

Methods

Observational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006–07) and post-program (2010–11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons.

Results

A 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age > 75 years: 53%) and 3142 post-program (age > 75 years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3 days to post-program 5.7 days, p < 0.001). Six hospitals provided cost data. Average per-episode costs decreased by 10% (pre-program AUD7888 to post-program AUD7115). After adjusting for age, sex, stroke type, and hospital, average per-episode costs decreased by 6.1% from pre to post program (p = 0.025). When length of stay was additionally adjusted for, these costs increased by 10.8%, indicating a greater mean cost per day (p < 0.001).

Conclusion

Cost containment of acute inpatient episodes was observed after the implementation of stroke clinical facilitators, likely associated with the shorter lengths of stay. (So you pushed them out faster regardless of their lack of recovery? Good to know where the hospital priorities are. )