Abstract W P327: Defect-Free Stroke Care Results in Lower Hospitalization Costs

Abstract

Background: Defect-free hospital care suggests greater quality and may provide better outcomes for acute ischemic stroke(AIS) patients. Previously we reported a 5-item stroke care bundle that was associated with an increased likelihood of favorable discharge status (home/acute rehabilitation). The effect of defect-free care on total cost of hospitalization remains unknown. Hypothesis: Defect-free compliance to a 5-item stroke care bundle will result in significant cost savings while improving clinical outcomes. Methods: A retrospective cohort study of hospitalized AIS patients 18 years or older was conducted at 6 Intermountain Healthcare facilities from 2009-2012. Defect-free care was defined as compliance with 5 care measures: ED arrival to head CT <25 minutes, DTN <60 minutes, discharge on an anti-platelet, anticoagulation for patients with atrial fibrillation, and statin medication at discharge. All patients who met eligibility criteria for any measure were included. Generalized Linear Mixed (GLIMMIX) Model with random intercepts controlling for Charlson Comorbidity Index Score (CCIS) and age assessed the association of “Defect-Free” care with the following outcomes: favorable discharge status, inflation rate adjusted total cost, and 30-day readmission rate. Results: A total of 3,568 patients were analyzed. Patients receiving defect free care had higher rate of favorable discharge status (77.7% vs. 68.7%, p<0.0001) (Table1), and lower adjusted total costs ($10,354 vs. $11,530, p=0.0312), but showed no difference in their 30 day readmission rates (10.1% vs. 10.6%, p=0.7244), compared to patients not receiving defect-free care. After controlling for CCIS and age in a GLIMMIX model, patients receiving defect-free care were more likely to have a favorable discharge status (OR=1.295, 95% CI: 1.038, 1.615) and saved $659 on adjusted cost per case resulting in an estimated $1.9 million in savings on hospitalization costs over the study period.