Abstract
BackgroundComparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA.MethodsMedical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG.ResultsSeventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital.ConclusionsUtilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.
Highlights
Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations
Diringer and colleagues [2] examined the breakdown of hospital costs in 191 individuals presenting with acute ischemic stroke to a single tertiary care academic hospital
Most baseline patient characteristics, including risk factors for stroke, were similar between the two hospitals, functional deficits prior to the onset of stroke were more common in patients treated at the community hospital as compared to the university (34% v. 16%, p < 0.01)
Summary
Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. The overall direct and indirect costs associated with stroke in the United States alone are estimated at $62.7 billion in 2007 [1]. Diringer and colleagues [2] examined the breakdown of hospital costs in 191 individuals presenting with acute ischemic stroke to a single tertiary care academic hospital. These researchers estimated 50% of costs were attributed to bed charges (16% ICU, 34% ward). Reed [3] argued that different types of hospitals should be examined separately as costs can differ dramatically between facilities These researchers found that costs in teaching community hospitals were 10-30% greater than those at non-teaching community hospitals. They estimated that, overall, community hospital costs were approximately 10-20% lower than academic medical center costs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
