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Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model

Author

Listed:
  • Rachael Maree Hunter
  • Charles Davie
  • Anthony Rudd
  • Alan Thompson
  • Hilary Walker
  • Neil Thomson
  • James Mountford
  • Lee Schwamm
  • John Deanfield
  • Kerry Thompson
  • Bikash Dewan
  • Minesh Mistry
  • Sadik Quoraishi
  • Stephen Morris

Abstract

Background: In July 2010 a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, UK, with continuous specialist care during the first 72 hours provided at 8 hyper-acute stroke units (HASUs) compared to the previous model of 30 local hospitals receiving acute stroke patients. We investigated differences in clinical outcomes and costs between the new and old models. Methods: We compared outcomes and costs ‘before’ (July 2007–July 2008) vs. ‘after’ (July 2010–June 2011) the introduction of the new model, adjusted for patient characteristics and national time trends in mortality and length of stay. We constructed 90-day and 10-year decision analytic models using data from population based stroke registers, audits and published sources. Mortality and length of stay were modelled using survival analysis. Findings: In a pooled sample of 307 patients ‘before’ and 3156 patients ‘after’, survival improved in the ‘after’ period (age adjusted hazard ratio 0.54; 95% CI 0.41–0.72). The predicted survival rates at 90 days in the deterministic model adjusted for national trends were 87.2% ‘before’ % (95% CI 86.7%–87.7%) and 88.7% ‘after’ (95% CI 88.6%–88.8%); a relative reduction in deaths of 12% (95% CI 8%–16%). Based on a cohort of 6,438 stroke patients, the model produces a total cost saving of £5.2 million per year at 90 days (95% CI £4.9-£5.5 million; £811 per patient). Conclusion: A centralized model for acute stroke care across an entire metropolitan city appears to have reduced mortality for a reduced cost per patient, predominately as a result of reduced hospital length of stay.

Suggested Citation

  • Rachael Maree Hunter & Charles Davie & Anthony Rudd & Alan Thompson & Hilary Walker & Neil Thomson & James Mountford & Lee Schwamm & John Deanfield & Kerry Thompson & Bikash Dewan & Minesh Mistry & Sa, 2013. "Impact on Clinical and Cost Outcomes of a Centralized Approach to Acute Stroke Care in London: A Comparative Effectiveness Before and After Model," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
    • Handle: RePEc:plo:pone00:0070420
    DOI: 10.1371/journal.pone.0070420
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    References listed on IDEAS

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    1. Billingsley Kaambwa & Lucinda Billingham & Stirling Bryan, 2013. "Mapping utility scores from the Barthel index," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 231-241, April.
    2. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
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    Cited by:

    1. World Bank Group, 2018. "Romania Regional Hospital Analysis Study," World Bank Publications - Reports 30168, The World Bank Group.
    2. Rachel Meacock & Tim Doran & Matt Sutton, 2015. "What are the Costs and Benefits of Providing Comprehensive Seven‐day Services for Emergency Hospital Admissions?," Health Economics, John Wiley & Sons, Ltd., vol. 24(8), pages 907-912, August.
    3. VAN DER LINDEN, M. Christien & VAN DER LINDEN, Naomi & LAM, Rianne C. & STAP, Peter & VAN DEN BRAND, Crispijn L. & VERMEULEN, Tamara & JELLEMA, Korné & VAN DEN WIJNGAARD, Ido R., 2021. "Impact of ongoing centralization of acute stroke care from “drip and ship” into “direct-to-mothership” model in a Dutch urban area," Health Policy, Elsevier, vol. 125(8), pages 1040-1046.
    4. Rocco Friebel & Katharina Hauck & Paul Aylin, 2018. "Centralisation of acute stroke services in London: Impact evaluation using two treatment groups," Health Economics, John Wiley & Sons, Ltd., vol. 27(4), pages 722-732, April.
    5. Caroline S. Clarke & Cecilia Vindrola-Padros & Claire Levermore & Angus I. G. Ramsay & Georgia B. Black & Kathy Pritchard-Jones & John Hines & Gillian Smith & Axel Bex & Muntzer Mughal & David Shackle, 2021. "How to Cost the Implementation of Major System Change for Economic Evaluations: Case Study Using Reconfigurations of Specialist Cancer Surgery in Part of London, England," Applied Health Economics and Health Policy, Springer, vol. 19(6), pages 797-810, November.

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