Clinical efficiency tools improve stroke management in a rural southern health system.
Background and Purpose-Ischemic stroke is a high-volume and financially draining diagnosis at this rural health system.
The purpose of this clinical practice analysis was to identify resource utilization and clinical process inefficiencies and to promote clinically efficient, evidence-based improvements.
Methods-A retrospective analysis of medical record and financial databases of 356 patients with ischemic stroke was performed.
The medical record data were adjusted for severity, and outliers were eliminated.
The resources utilized by each physician were determined.
Comparative graphs were prepared, presented, and discussed.
The physicians implemented two types of changes : (1) alteration of resource utilization and consultation patterns and (2) support of clinical process improvement.
In 1997, a follow-up analysis of 399 patients was performed.
The initial comparison of internists'to neurologists'patient populations found the following :
patient age (75 versus 65 years), patient severity ratings (2.8 versus 2.5), length of stay (10.7 versus 8.8 days), costs ($7360 versus $6862), mortality rates (12.5% versus 8.9%), and aspiration pneumonia rate (8.5% versus 3.8%). A comparison of the 1995 analysis to the 1997 analysis revealed the following per patient resource utilization decreases (all P<0.05) : chemistry laboratory, 2.65 to 1.95 studies ;
intravenous fluids, 2.85 to 1.85 L ;
oxygen use, 6.06 to 2.75 U ;
and nifedipine use, 1.62 to 0.33 capsules. (...)
Mots-clés Pascal : Ischémie, Encéphale, Coût, Optimisation, Ressource, Diagnostic, Traitement, Etude critique, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Politique sanitaire, Economie santé
Mots-clés Pascal anglais : Ischemia, Brain (vertebrata), Costs, Optimization, Resource, Diagnosis, Treatment, Critical study, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease, Health policy, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0320285
Code Inist : 002B30A04D. Création : 27/11/1998.