Stroke Prevention and Care

Safely Reducing the Cost of Faster Treatment

CERC’s stroke model uncovered strategies to dramatically improve stroke outcomes while at the same time lowering costs. Estimated savings from implementation of the CERC model is $1.6 billion dollars in direct healthcare spending per year.

Ischemic cerebrovascular disease is a leading cause of disability in the United States, annually causing nearly 700,000 strokes and other significant complications including dementia and transient ischemic attacks. The national price tag for stroke care is $20.6 billion per year in direct health-care spending.

The team identified addressable failure points in current methods to prevent and treat strokes and addressed them with these three core elements:

·      The use of nurse-led teams to increase patient use of protective medications from 60% to over 85% to prevent stroke and thereby avoid downstream costs resulting from hospital care, rehabilitation/nursing home care, and direct health care costs related to stroke disability.

·      The replacement of hospitalization with home-based care for most patients who have experienced a transient or mild stroke following a brief evaluation in a hospital emergency department.

·      The application of a rapid treatment protocol to reduce the delay in the usage of clot-dissolving medication by 50 minutes for patients with severe strokes, as these patients lose an estimated 1.9 million brain cells for every minute of treatment delay.

Lucy Kalanithi ,MD, Amy Tai, MD, Jared Conley, PhD, Terry Platchek, MD, Donna Zulman MD MS, Arnold Milstein MD MPH, 2013

© 2018 A. Milstein / Stanford University

Publications by CERC faculty and fellows


What can be achieved by redesigning stroke care for a value-based world?

Expert Rev Pharmacoecon Outcomes Res 2014 Oct:15(5):585:7.

Better health, less spending: delivery innovation for ischemic cerebrovascular disease

Stroke 2014 Oct;45(10):3105-11. 

Cost-saving innovations for acute ischemic stroke and transient ischemic attack

Neurology Clinical Practice 2014; 4(5): 427-34