Stroke Prevention and Care

Fellowship Year 2012-2013

Stroke Prevention and Care Model

Background: 

Ischemic cerebrovascular disease (CVD) is a leading cause of disability in the United States.CVD causes almost 700,000 strokes annually and other significant complications includingdementia and transient ischemic attacks (TIA). In 2014, roughly $48 billion was spent in the USto prevent CVD and other cardiovascular diseases and to treat strokes.

Safely reducing per capita stroke spending:

CERC’s stroke care redesign team found five addressable failure points in current methods toprevent and treat strokes, summarized in the table below. Team members addressed these failurepoints via a new care model with three core elements: (1) the use of nurse-led teams to increasepatient use of protective medications from 60% to over 85% to prevent stroke and thereby avoiddownstream costs resulting from hospital care, rehabilitation/nursing home care, and directhealthcare costs related to stroke disability; (2) the replacement of hospitalization with home-based care for most patients who have experienced a transient or mild stroke following a briefevaluation in a hospital emergency department; and (3) the application of a rapid treatmentprotocol to reduce the delay in the usage of clot-dissolving medication by 50 minutes forpatients with severe strokes, as these patients lose an estimated 1.9 million brain cells for everyminute of treatment delay.

Estimated savings:

A conservative estimate of national savings from full implementation of the CERC model is $2.1 billion dollars in direct healthcare spending per year, or 1.45% of annual spending fortreatment of cerebrovascular disease.(Estimation of savings reflects midpoints of ranges of savings across three core elements.)

Authors: 

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

Link to the paper:

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.114.006236

© 2018 A. Milstein / Stanford University