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 including dementia and transient ischemic attacks (TIA). In 2014, roughly $48 billion was spent in the US to prevent CVD and other cardiovascular diseases and to treat strokes.
Projects and Outcomes
CERC’s care redesign team developed a new care model with three core elements:
- The use of nurse-led teams to increase from 60% to over 85% patient use of protective medications to prevent stroke and thereby downstream costs resulting from hospital care, rehabilitation/nursing home care, and direct 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
- A rapid treatment protocol to reduce the usage delay by 50 minutes of clot-dissolving medication for patients with severe strokes, as these patients lose an estimated 1.9 million brain cells for every minute of treatment delay
Testing took place at Stanford Hospital in 2014 and at Virginia Mason Hospital 2016-19. Broad implementation occurred via all Kaiser Permanente Northern California hospitals in 2016.