Prospective Interventions to Reduce Stroke Care Variation in a Hub-and-Spokes System

WOW! This is about wasted spending NOT  getting survivors recovered!. Who the fuck approved this crapola?

There should be zero variation among services provided. You follow the protocols exactly that lead to 100% recovery, starting with an objective diagnosis that leads directly to reperfusion interventions, that leads directly to neuronal cascade of death prevention, that leads directly to rehab protocols based upon the objective disabilities left.

Prospective Interventions to Reduce Stroke Care Variation in a Hub-and-Spokes System

• Rohini Bhole, MD, MS
• Angela M. Sales, BSN, RN
• Anupam Lahiri, MBA
• 
  
• Robin J. Womeodu, MD
• Arthur M. Townsend, MD, MBA
• Andrei V. Alexandrov, MD
• Show all authors

Published:December 15, 2021DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106218

Abstract

Background

Care variation reduction (CVR) is a central objective of quality management to decrease wasted spending.

Objective

To analyze stroke care variation at a hub-and-spokes system and determine interventions to prospectively reduce unwarranted variation.

Methods

In this prospective cohort single arm intervention study providers were blinded to pre-specified endpoints. Care variation was measured for DRGs 61-66 and 69 in USD, and severity level by Case Mix Index (CMI) by provider. A multi-disciplinary task force chaired by Vascular Neurologist analyzed data extracted from Crimson, a patient centric data analysis tool, and determined interventions. The primary measure outcome was change in CMI post intervention.

Results

Annualized baseline care variation was $ 0.7-1.2M (2017) in a drip-and-ship thrombolytic treatment model within the hub-and-spokes system. Pharmacy expenses contributed to 42% of variation followed by laboratory 12%, physical therapy 11%, supplies 11% and imaging 9%. Interventions to achieve CVR were prospectively implemented in 2018 and CVR was measured in January 2019. Based on 2017 CMI of 1.28, the goal of intervention was set to achieve 7% increase to 1.37 with projected increased revenue of $774,144. After implementation of interventions the actual achieved average CMI in 2018 was 1.40 paralleled by improvement in secondary outcomes of length of stay, observed over expected mortality and re-admission.

Conclusions

A drip-and-ship stroke model within a single hub-and-spokes healthcare system can achieve substantial reduction in care variation and associated cost along with improvement in patient care indicators.

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