Stroke Prevention and Care

Fellowship Year 2012-2013

Stroke Prevention and Care Model


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.)


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:

© 2018 A. Milstein / Stanford University