The Cost of Implementing and Sustaining the COMprehensive Post-Acute Stroke Services Model
| Autor: | Jacqueline R. Halladay, William S. Bayliss, Janet K. Freburger, Anna Kucharska-Newton, Cheryl Bushnell, Pamela W. Duncan, Justin G. Trogdon |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Percentile animal structures Cost estimate Cost-Benefit Analysis Article 03 medical and health sciences 0302 clinical medicine Surveys and Questionnaires Compass North Carolina medicine Cluster Analysis Humans Transitional care 030212 general & internal medicine Activity-based costing health care economics and organizations Acute stroke Stroke services business.industry 030503 health policy & services Stroke Rehabilitation Public Health Environmental and Occupational Health Health Care Costs Stroke volume Stroke Emergency medicine 0305 other medical science business Subacute Care |
| Zdroj: | Med Care |
| ISSN: | 0025-7079 |
| DOI: | 10.1097/mlr.0000000000001462 |
| Popis: | BACKGROUND: The COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged home, was tested against status quo post-acute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. This study examined the hospital-level costs associated with implementing and sustaining COMPASS. METHODS: Using an activity-based costing survey, we estimated hospital-level resource costs spent on COMPASS-related activities during approximately 1 year. We identified hospitals that were actively engaged in COMPASS during the year prior to the survey and collected resource cost estimates from 22 hospitals. We used median wage data from the Bureau of Labor Statistics and COMPASS enrollment data to estimate the hospital-level costs per COMPASS enrollee. RESULTS: Between November 2017 and March 2019, 1,582 patients received the COMPASS intervention across the 22 hospitals included in this analysis. Average annual hospital-level COMPASS costs were $2,861 per patient (25th percentile: $735; 75th percentile: $3,475). Having 10 percent higher stroke patient volume was associated with 5.1 percent lower COMPASS costs per patient (P=.016). About half (N=10) of hospitals reported post-acute clinic visits as their highest-cost activity, while a third (N=7) reported case ascertainment (i.e., identifying eligible patients) as their highest-cost activity. CONCLUSIONS: We found that the costs of implementing COMPASS varied across hospitals. On average, hospitals with higher stroke volume and higher enrollment reported lower costs per patient. Based on average costs of COMPASS and readmissions for stroke patients, COMPASS could lower net costs if the model is able to prevent about 6 readmissions per year. |
| Databáze: | OpenAIRE |
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