Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport

 Since you didn't specify 100% recovery I assume your excellent outcome is just you trying to use the tyranny of low expectations to justify this as a success. I consider anything less than 100% recovery a failure.  Prove to me where I'm wrong, I dare you.

Quantifying Improved Outcomes, Cost Savings, and Hospital Volume Changes From Optimized Emergency Stroke Transport

Daniel A. Paydarfar,

Jessalyn K. Holodinsky,

Huda Abbas,

Thalia S. Field,

Lily W. Zhou and

Noreen Kamal

Originally published26 Aug 2022https://doi.org/10.1161/STROKEAHA.122.039172Stroke. 2022;0:10.1161/STROKEAHA.122.039172

Abstract

Background:

A previously published conditional probability model optimizes prehospital emergency transport protocols for patients with suspected large-vessel occlusion by recommending the transport strategy, drip-and-ship or mothership, that results in a higher probability of an excellent outcome. In this study, we create generalized models to quantify the change in annual hospital patient volume, the expected annual increase in the number of patients with an excellent outcome, and the annual cost savings to a single-payer healthcare system resulting from these optimized transport protocols.

Methods:

We calculated the expected number of patients with suspected large-vessel occlusion transported by ambulance over a 1-year period in a region of interest, using the annual stroke incidence rate and a large-vessel occlusion screening tool. Assuming transport to the closest hospital is the baseline transport policy across the region (drip-and-ship), we determined the change in annual hospital patient volume from implementing optimized transport protocols. We also calculated the resulting annual increase in the number of patients with an excellent outcome (modified Rankin Score of 0–1 at 90 days) and associated cost savings to a single-payer healthcare system. We then performed a case study applying these generalized models to the stroke system serving the Greater Vancouver and Fraser Valley Area, BC, Canada.

Results:

In the Greater Vancouver and Fraser Valley Area, there was an annual increase of 36 patients with an excellent outcome, translating to an annual cost savings of CA$2 182 824 to the British Columbia healthcare system. We also studied how these results change depending on our assumptions of treatment times at the regional stroke centers.

Conclusions:

Our framework quantifies the impact of optimized emergency stroke transport protocols on hospital volume, outcomes, and cost savings to a single-payer healthcare system. When applied to a specific region of interest, these models can help inform health policies concerning emergency transport of patients with suspected large-vessel occlusion.

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Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis

Survivors don't want predictions of excellent outcome, they want to have PROTOCOLS THAT DELIVER AN EXCELLENT OUTCOME.

 Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis

1. Nolwenn Riou-Comte1,
2. Benjamin Gory2,
3. http://orcid.org/0000-0001-5814-6924Marc Soudant3,
4. François Zhu2,
5. Yu Xie2,
6. Lisa Humbertjean1,
7. Gioia Mione1,
8. Catherine Oppenheim4,
9. Francis Guillemin3,
10. Serge Bracard2,
11. http://orcid.org/0000-0002-0945-5656Sébastien Richard1
12. on behalf of the THRACE investigators

1. Correspondence to Professor Sébastien Richard; s.richard@chru-nancy.fr

Abstract

Background 

 For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT.

Methods 

We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic.

Results 

Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80).

Conclusions 

In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm.

Trial registration number NCT01062698.

Data availability statement

Data are available on reasonable request. Only data that are relevant for the main objective of this ancillary study were available from the THRACE trial in agreement with the principal investigator of the trial. Individual de-identified participant data were shared following the explanation of the main objective and the statistical analysis. Data are available on reasonable request to SR (s.richard@chru-nancy.fr).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/svn-2020-000852