- Email: [email protected]
1191 Development of an integrated model of care for the rural stroke patient: the rural stroke needs study
$404
Poster Abstracts
Thursday, November 10, 2005
Methods: Data from the Integrated Healthcare Information Services
Background: Risk factor and post-stroke depression management are
managed care database were used to estimate annual per-patient costs of ICH. Plan enrollees aged 18+ years hospitalized with a primary ICD-9-CM diagnosis of 431.xx during July 1999-June 2002 were selected. Persons enrolled < 6 months prior to their hospitalization, or who used services listing a 430.xx-432.xx diagnosis code during that 6-month period, were excluded. Resource utilization/costs associated with the initial hospitalization were calculated for all patients. Patients who had medical/pharmacy claims following the initial hospital discharge were assumed to have survived tile iuitial hospitalization. Post-discharge use/cost of healthcare services (repeat hospitalization, skilled nursing/rehabilitation services, outpatient use, pharmacy) were estimated for up to 365 days following hospital discharge for patients surviving the initial stay. Results: 46% of ICH patients (in - 493; mean age -- 63.8 years) were aged < 65 years, and 60% had private health insurance. Patients who died during their iuitial ICH hospitalization (38.4%) incurred treatment costs o f $16,466. Survivors incurred initial hospitalization costs of $28,360 and first-year post-discharge costs o f $16,035. Repeat hospitalizations were observed in 8% of ICH patients; whereas 41% used post-discharge skilled nursing/rehab services. Conclusions: ICH treatment costs to private payers are considerable, and reflect a sizable long-term financial burden to health plans in tile US. The need for effective intervention in the acute stage of disease is critical to reduce the long-term cost burden.
both pre-eminently suited to general practitioner (GP)-based intervention, placing tire GP in an important position after a stroke in secondary prevention. Tiffs is particularly so in under-serviced rural areas. There are little data available on management of vascular risk factors and post stroke depression in rural Australia. There is early data available from Canada and Besancon, France. X~Vorld-wide, there are widespread differences in the implementation of recommendations for secondary stroke prevention by primary care physicians, and there is little evidence that tile GPs behaviour is siguificantly affected by current information dissenffnation. To address this an integrated model o f care (shared care) is proposed. Methods: Employing a semi-structured interview method, a datamining exercise addressing post-discharge care o f rural stroke patients will take place in three rural Australian areas (Shepparton, Gippsland and Warnambool). This will address issues such as process of care, barriers to care as perceived by patients, rural hospital physicians, rural GPs, carers and district nursing staff'. Data from the rural Australian setting will be compared with Canadian and French data. Discussion: This data will inform a model of integrated (shared) care for the rural stroke patient that will be tested in a randomized control trial in the Australian, Canadian and French settings. This will be modified according to tile results of tiffs Australian study as well as Canadian and French data, but will be based on tile successful urban model of integrated care currently employed at the Royal Melbourne Hospital.
1190 Intracerebral Hemorrhage versus Ischemic Stroke: differences in hospitalization outcomes
1192 Causes of Isetlemie Stroke among young WOnlen Of Serbia
Joshi, A ~, Russell, M, Boulanger, L, Neumann, P, Menzin, J. 1Novo
Jovanovic, D. ~, Beslac-Bumbasirevic, LJ 1, Savic, 01. 1Institute of
Nordisk Inc, Princeton, USA
Neurology, Clinical Center of Serbia, Belgrade, Serbia and Mon ten egro
Background: Intracerebral hemorrhage (ICH) and ischemic strokes
Background: The Serbian Burden of Disease Study has shown that
impose a sizable healthcare burden in developed nations; their comparative outcomes have not been assessed in recent years. Methods: The 2002 US Healthcare Cost and Utilization Project (HCUP) database was used to examine acute-care in-hospital outcomes in adults with ICH vs. ischemic stroke. Tile H C U P database includes all discharges fi'om 995 short-stay acute-care hospitals in 35 US states; the sampling frame approximates a 20% national sample. Patients were identified based on primary ICD-9-CM discharge diagnosis of ICH (431.~x), subarachnoid (SAH) (430.ro0, other hemorrhage (IH) (432.xx), or ischemic (433M35) stroke. Variables included patient-level information (age, gender and ethnicity), hospital characteristics (teaching status, urban/rural location, bedcount, geographic region), comorbidities, inpatient mortality, primary payer, admission source, discharge destination, DRG, length-of-stay (LOS), and hospital charges. Hospital-specific cost-to-charge ratios were applied to charge data. The impact of stroke sub-type on costs after adjusting for above covariates including inpatient mortality was assessed through multivariate least-squares regression. Results: As compared to patients with ischemic stroke (in -- 146,785), ICH patients (n -- 13,239) were more likely to be nonwhite (22.4% vs. 15%) with higher inpatient mortality (31.2% vs. 3.3%). Average hospitalization costs (LOS days) were $32,579 (11.8), $15,140 (7.7), $15,624 (17.6), and $8,900 (15.3) for SAH, ICH, IH and ischemic stroke, respectively. Ill tile multivariate analysis, adjusted costs of SAH, ICH, and IH were $10,881, $866, and $1,569 higher than ischemic stroke, respectively (iJ < 0.001; Adjusted R a -- 63%). Conclusions: US patients with ICH experience significantly higher inpatient mortality and hospital costs than ischemic stroke patients.
cerebrovascular disease is the first cause of death among women. As tile stroke prevention is essentially based on tile treatment of risk factors it is of high importance to identify causes of stroke among women. This study has evaluated the risk factors and causes of ischemic stroke (IS) among young woman of Serbia during previous 16 years. Method: A total of 357 consecutive women with IS, aged 15 to 45 years, were managed by the pre-designed protocol from 1989 2004. Etiologic diagnostic tests were perfomled on case-by-case basis and according to their availability at the time. All the causes were classified according to the TOAST criteria. Results: Among 357 women with IS there were 23% of them with <30 years, 8% with TIA and 8% died during tile initial hospitalization. The stroke onset was during pregnancy or puevperium in 41 women. The large-artery atherosclerosis was confirmed in 9%, the small-artery disease in 12%, the embolism in 21% and the other causes in 19% of patients. Hypertension (31%), smoking (22%) and hyperlipidemia (21%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were tile most common causes of tile IS. Arterial dissections and coagulation inhibitors deficit were detected in a small number of patients. Conehision: According to the detected risk factors and causes of IS in young women, the stroke prevention in Serbia should be more vigorous. 1193 Tile lirst Thrombolysis service in tile Arabian Gulf (State of Qatar) evaluation and outcome
Karrlran, S ~. 1Hamad General Hospital, Qatar 1191 Development of an integrated inodel of care for tile rural Stroke patient: the rural Stroke needs study Joubert, j 1 2Royal Melbourne Hospital, Vicwria, Australia
Methods: Between January 2002 and April 2003, 37 patients were
evaluated for thrombolysis. Stroke thrombolysis specialist made all treatment decisions, including reading CT for early ischemic changes (EIC) and obtaiuing written informed consent. The on call radiologist
Poster Abstracts
Thursday, November 10, 2005
Methods: Data from the Integrated Healthcare Information Services
Background: Risk factor and post-stroke depression management are
managed care database were used to estimate annual per-patient costs of ICH. Plan enrollees aged 18+ years hospitalized with a primary ICD-9-CM diagnosis of 431.xx during July 1999-June 2002 were selected. Persons enrolled < 6 months prior to their hospitalization, or who used services listing a 430.xx-432.xx diagnosis code during that 6-month period, were excluded. Resource utilization/costs associated with the initial hospitalization were calculated for all patients. Patients who had medical/pharmacy claims following the initial hospital discharge were assumed to have survived tile iuitial hospitalization. Post-discharge use/cost of healthcare services (repeat hospitalization, skilled nursing/rehabilitation services, outpatient use, pharmacy) were estimated for up to 365 days following hospital discharge for patients surviving the initial stay. Results: 46% of ICH patients (in - 493; mean age -- 63.8 years) were aged < 65 years, and 60% had private health insurance. Patients who died during their iuitial ICH hospitalization (38.4%) incurred treatment costs o f $16,466. Survivors incurred initial hospitalization costs of $28,360 and first-year post-discharge costs o f $16,035. Repeat hospitalizations were observed in 8% of ICH patients; whereas 41% used post-discharge skilled nursing/rehab services. Conclusions: ICH treatment costs to private payers are considerable, and reflect a sizable long-term financial burden to health plans in tile US. The need for effective intervention in the acute stage of disease is critical to reduce the long-term cost burden.
both pre-eminently suited to general practitioner (GP)-based intervention, placing tire GP in an important position after a stroke in secondary prevention. Tiffs is particularly so in under-serviced rural areas. There are little data available on management of vascular risk factors and post stroke depression in rural Australia. There is early data available from Canada and Besancon, France. X~Vorld-wide, there are widespread differences in the implementation of recommendations for secondary stroke prevention by primary care physicians, and there is little evidence that tile GPs behaviour is siguificantly affected by current information dissenffnation. To address this an integrated model o f care (shared care) is proposed. Methods: Employing a semi-structured interview method, a datamining exercise addressing post-discharge care o f rural stroke patients will take place in three rural Australian areas (Shepparton, Gippsland and Warnambool). This will address issues such as process of care, barriers to care as perceived by patients, rural hospital physicians, rural GPs, carers and district nursing staff'. Data from the rural Australian setting will be compared with Canadian and French data. Discussion: This data will inform a model of integrated (shared) care for the rural stroke patient that will be tested in a randomized control trial in the Australian, Canadian and French settings. This will be modified according to tile results of tiffs Australian study as well as Canadian and French data, but will be based on tile successful urban model of integrated care currently employed at the Royal Melbourne Hospital.
1190 Intracerebral Hemorrhage versus Ischemic Stroke: differences in hospitalization outcomes
1192 Causes of Isetlemie Stroke among young WOnlen Of Serbia
Joshi, A ~, Russell, M, Boulanger, L, Neumann, P, Menzin, J. 1Novo
Jovanovic, D. ~, Beslac-Bumbasirevic, LJ 1, Savic, 01. 1Institute of
Nordisk Inc, Princeton, USA
Neurology, Clinical Center of Serbia, Belgrade, Serbia and Mon ten egro
Background: Intracerebral hemorrhage (ICH) and ischemic strokes
Background: The Serbian Burden of Disease Study has shown that
impose a sizable healthcare burden in developed nations; their comparative outcomes have not been assessed in recent years. Methods: The 2002 US Healthcare Cost and Utilization Project (HCUP) database was used to examine acute-care in-hospital outcomes in adults with ICH vs. ischemic stroke. Tile H C U P database includes all discharges fi'om 995 short-stay acute-care hospitals in 35 US states; the sampling frame approximates a 20% national sample. Patients were identified based on primary ICD-9-CM discharge diagnosis of ICH (431.~x), subarachnoid (SAH) (430.ro0, other hemorrhage (IH) (432.xx), or ischemic (433M35) stroke. Variables included patient-level information (age, gender and ethnicity), hospital characteristics (teaching status, urban/rural location, bedcount, geographic region), comorbidities, inpatient mortality, primary payer, admission source, discharge destination, DRG, length-of-stay (LOS), and hospital charges. Hospital-specific cost-to-charge ratios were applied to charge data. The impact of stroke sub-type on costs after adjusting for above covariates including inpatient mortality was assessed through multivariate least-squares regression. Results: As compared to patients with ischemic stroke (in -- 146,785), ICH patients (n -- 13,239) were more likely to be nonwhite (22.4% vs. 15%) with higher inpatient mortality (31.2% vs. 3.3%). Average hospitalization costs (LOS days) were $32,579 (11.8), $15,140 (7.7), $15,624 (17.6), and $8,900 (15.3) for SAH, ICH, IH and ischemic stroke, respectively. Ill tile multivariate analysis, adjusted costs of SAH, ICH, and IH were $10,881, $866, and $1,569 higher than ischemic stroke, respectively (iJ < 0.001; Adjusted R a -- 63%). Conclusions: US patients with ICH experience significantly higher inpatient mortality and hospital costs than ischemic stroke patients.
cerebrovascular disease is the first cause of death among women. As tile stroke prevention is essentially based on tile treatment of risk factors it is of high importance to identify causes of stroke among women. This study has evaluated the risk factors and causes of ischemic stroke (IS) among young woman of Serbia during previous 16 years. Method: A total of 357 consecutive women with IS, aged 15 to 45 years, were managed by the pre-designed protocol from 1989 2004. Etiologic diagnostic tests were perfomled on case-by-case basis and according to their availability at the time. All the causes were classified according to the TOAST criteria. Results: Among 357 women with IS there were 23% of them with <30 years, 8% with TIA and 8% died during tile initial hospitalization. The stroke onset was during pregnancy or puevperium in 41 women. The large-artery atherosclerosis was confirmed in 9%, the small-artery disease in 12%, the embolism in 21% and the other causes in 19% of patients. Hypertension (31%), smoking (22%) and hyperlipidemia (21%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were tile most common causes of tile IS. Arterial dissections and coagulation inhibitors deficit were detected in a small number of patients. Conehision: According to the detected risk factors and causes of IS in young women, the stroke prevention in Serbia should be more vigorous. 1193 Tile lirst Thrombolysis service in tile Arabian Gulf (State of Qatar) evaluation and outcome
Karrlran, S ~. 1Hamad General Hospital, Qatar 1191 Development of an integrated inodel of care for tile rural Stroke patient: the rural Stroke needs study Joubert, j 1 2Royal Melbourne Hospital, Vicwria, Australia
Methods: Between January 2002 and April 2003, 37 patients were
evaluated for thrombolysis. Stroke thrombolysis specialist made all treatment decisions, including reading CT for early ischemic changes (EIC) and obtaiuing written informed consent. The on call radiologist