Process Improvement and Cost Savings in Stroke and TIA Care

The looming healthcare financial crisis in America led to the creation of the Stanford Clinical Excellence Research Center (CERC). The mission of the program is: "better health, less spending." CERC brings together individuals with backgrounds in medicine, industrial engineering, and management and social sciences in an effort to create innovative healthcare delivery models that safely lower per capita spending while maintaining or improving health outcomes and patient experience. The goal is to bend the national trend of the ever increasing portion of our national GDP being spent on healthcare. Stanford Stoke Center faculty member Amy Tai is collaborating with CERC on a novel stroke/TIA heath care delivery project.

Stroke is the leading cause of disability and eighth most expensive health condition in America. Dr. Tai spent a year working on a redesigned care delivery process to address the gaps in the current system of stroke care in the United States.  An innovative stroke care model was developed using a systematic design method that included: (1) A literature review of major guidelines, stroke care delivery methods, and cost effectiveness studies to identify the best practices and how to achieve them at the lowest cost; (2) Site visits with those identified to be best at delivering high quality care for the lowest cost; (3) Observations of patients and providers to identify their unmet needs; (4) Development of a model to address stakeholders' unmet needs using methods from design thinking and health care delivery science; (5) Estimation of the model's cost-saving potential, using national averages for risk factor prevalence, stroke incidence, and costs of conditions and interventions.

Synthesis of this design process yielded a high-value stroke care model that: (1) prevents strokes through maximal use of preventative medications; (2) stratifies care for patients with TIA and mild stroke symptoms and; (3) delivers tPA in most time-efficient way possible and delivers a strengthened transition to community program for those at high risk for readmissions.  It is estimated that this model will significantly improve patient outcomes and reduce healthcare spending in cerebrovascular disease by 11%.