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Title: Changes in acute hospital costs after employing clinical facilitators to improve stroke care in Victoria, Australia.
Austin Authors: Cadilhac, Dominique A;Dewey, Helen M;Denisenko, Sonia;Bladin, Christopher F;Meretoja, Atte
Affiliation: Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
System Design, Planning & Decision Support Unit, Policy & Planning Branch, Department of Health and Human Services, Melbourne, Australia
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
Neurocenter, Helsinki University Hospital, Helsinki, Finland..
Eastern Health Clinical School, Monash University, Box Hill, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
System Design, Planning & Decision Support Unit, Policy & Planning Branch, Department of Health and Human Services, Melbourne, Australia
Issue Date: 18-Jan-2019 2019-01-18
Publication information: BMC health services research 2019; 19(1): 41
Abstract: Hospital costs for stroke are increasing and variability in care quality creates inefficiencies. In 2007, the Victorian Government (Australia) employed clinical facilitators for three years in eight public hospitals to improve stroke care. Literature on the cost implications of such roles is rare. We report changes in the costs of acute stroke care following implementation of this program. Observational controlled before-and-after cohort design. Standardised hospital costing data were compared pre-program (financial year 2006-07) and post-program (2010-11) for all admitted episodes of stroke or transient ischaemic attack (TIA) using ICD-10 discharge codes. Costs in Australian dollars (AUD) were adjusted to a common year 2010. Generalised linear regression models were used for adjusted comparisons. A 20% increase in stroke and TIA episodes was observed: 2624 pre-program (age > 75 years: 53%) and 3142 post-program (age > 75 years: 51%); largely explained by more TIA admissions (up from 785 to 1072). Average length of stay reduced by 22% (pre-program 7.3 days to post-program 5.7 days, p < 0.001). Six hospitals provided cost data. Average per-episode costs decreased by 10% (pre-program AUD7888 to post-program AUD7115). After adjusting for age, sex, stroke type, and hospital, average per-episode costs decreased by 6.1% from pre to post program (p = 0.025). When length of stay was additionally adjusted for, these costs increased by 10.8%, indicating a greater mean cost per day (p < 0.001). Cost containment of acute inpatient episodes was observed after the implementation of stroke clinical facilitators, likely associated with the shorter lengths of stay.
DOI: 10.1186/s12913-018-3836-9
ORCID: 0000-0001-8162-682X
PubMed URL: 30658645
Type: Journal Article
Subjects: Cost-benefit analysis
Appears in Collections:Journal articles

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