Cost-effective for Hospitals, Good for Patients

Photo: Patient in hospital

The researchers have clear evidence that
patients who get timely intervention do
best;© panthermedia.net/Alexander Raths

A central hub hospital delivering rapid stroke diagnosis and treatment partnering with typically smaller spoke hospitals in need of those services means more patients recover better and the network – and hospitals – make money, according to a study in the American Heart Association.

"We measure stroke treatment in reduced disability and improved function and we have clear evidence that patients who get timely intervention do best," said Doctor Jeffrey A. Switzer of Georgia Health Sciences University (GHS).

"If you are hospital administrator, you may like the idea conceptually but you have to be concerned about the risks of investing up front to do this. This is the first study to show that if it's set up correctly, a telestroke network will more than pay for itself."

Switzer is corresponding author on the study using five years of patient and hospital data from telestroke networks at GHS and the Mayo Clinic. Researchers plugged the data into a model designed to compare effectiveness and hospital costs with and without a telestroke network. The telestroke model has one hub and seven spokes, the average network size in the United States.

They found that annually with a network:

• 45 more patients would receive the clot buster tPA, or tissue plasminogen activator, the only Food and Drug Administration-approved stroke drug
• 20 more patients would receive endovascular therapy such as mechanically removing the clot from a blood vessel
• Six more patients would be discharged to their home instead of a nursing home
• The network made nearly 360,000 Dollars, with each spoke hospital making more than 100,000 Dollars

Major costs of telestroke networks include technology, technical support, transferring patients and paying physicians to take the extra call, said Switzer. "The question is whether it is in the interest of hospitals to develop networks that set up these telestroke relationships."

The study suggests it is. It supports a model emerging across the nation, where large, hub hospitals such as GHS Medical Center pay equipment and other costs smaller hospitals incur using their network. In the vast majority of cases, patients are seen via the network by stroke specialists in Augusta, eligible patients are given tPA at the spoke hospital then transported to GHS Health System for follow-up care. A new iteration in recent years has larger, urban hospitals also utilizing the guaranteed acute stroke care but keeping most patients at their hospital afterward. The larger hospitals pay for their own telestroke equipment but also receive larger reimbursement from public and private insurance for their service, benefiting hospitals and patients, Switzer said. "Patients receive quality care and can stay closer to home."

MEDICA.de; Source: Georgia Health Sciences University