Abstract WP406: Out of Pocket Costs for Pediatric Stroke Care

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Patricia Plumb ◽  
Eric Seiber ◽  
Michael M Dowling ◽  
JoEllen Lee ◽  
Timothy J Bernard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Costs ◽  
Indirect Costs ◽  
Stroke Care ◽  
Annual Income ◽  
Childhood Stroke ◽  
Medical Visits ◽  
Out Of Pocket Expenses ◽  
Wage Earners ◽  
Out Of Pocket Costs

Objective: Direct hospital costs have been reported for children who have had stroke, and are similar to direct costs for adults. There has been no information regarding the indirect costs families encounter that are not covered by insurance (i.e. out-of-pocket) costs. Knowing the magnitude of these costs will give a more complete understanding of the economic impact of childhood stroke. This study describes out-of-pocket costs families paid in the first year after a child’s ischemic stroke. Methods: 22 of 70 possible subjects were prospectively recruited at 4 centers in the US and Canada in 2008 and 2009 for the “Validation of the Pediatric NIH Stroke Scale” study, and their out-of-pocket costs were tracked for 1 year. Parents reported expenses every three months, including wages lost for hours they did not work, non-reimbursed costs for medical visits or other health care, and mileage. They provided estimates of annual income. We calculated total out-of-pocket costs in US dollars. We also reported costs as a proportion of annual income to account for regional differences in income. Results: Total median out-of-pocket cost for one year was $4354 (range 0-$28,666). Wage earners in two families lost their jobs. Out-of-pocket costs were greatest in the first three months after the incident stroke, with the largest proportion due to lost wages, followed by non-reimbursed healthcare, lodging, and transportation. Lost wages remained high in the second quarter, but fell by the third and fourth quarters. Healthcare costs remained stable for the 4 quarters. For the entire year median out-of-pocket costs represented 6.8% (range 0-81.9%) of annual income. Conclusions: Out-of-pocket expenses are significant for families following a child’s ischemic stroke. These median out-of-pocket expenses of $4300 are of particular concern given that the median American household has cash savings of only $3,860. These results can be combined with previous reports of childhood stroke costs to model the overall costs of childhood stroke. Childhood stroke creates an under-recognized cost to society because of decreased parental productivity due to lost hours from work.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

scholarly journals Expert opinion paper on cardiac imaging after ischemic stroke

2021 ◽  
Author(s):  
Renate B. Schnabel ◽  
Stephan Camen ◽  
Fabian Knebel ◽  
Andreas Hagendorff ◽  
Udo Bavendiek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Expert Opinion ◽  
Cardiac Imaging ◽  
Controlled Trial ◽  
Case Series ◽  
Stroke Care ◽  
Imaging Method ◽  
Cardiac Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Attack

AbstractThis expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

Integrative physiological assessment of cerebral hemodynamics and metabolism in acute ischemic stroke

2021 ◽  
pp. 0271678X2110337
Author(s):  
Jui-Lin Fan ◽  
Ricardo C Nogueira ◽  
Patrice Brassard ◽  
Caroline A Rickards ◽  
Matthew Page ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Autoregulation ◽  
Cerebral Perfusion ◽  
Prognostic Markers ◽  
Important Determinant ◽  
Stroke Care ◽  
Contentious Issue ◽  
Ischemic Tissue ◽  
Physiological Assessment

Restoring perfusion to ischemic tissue is the primary goal of acute ischemic stroke care, yet only a small portion of patients receive reperfusion treatment. Since blood pressure (BP) is an important determinant of cerebral perfusion, effective BP management could facilitate reperfusion. But how BP should be managed in very early phase of ischemic stroke remains a contentious issue, due to the lack of clear evidence. Given the complex relationship between BP and cerebral blood flow (CBF)—termed cerebral autoregulation (CA)—bedside monitoring of cerebral perfusion and oxygenation could help guide BP management, thereby improve stroke patient outcome. The aim of INFOMATAS is to ‘ identify novel therapeutic targets for treatment and management in acute ischemic stroke’. In this review, we identify novel physiological parameters which could be used to guide BP management in acute stroke, and explore methodologies for monitoring them at the bedside. We outline the challenges in translating these potential prognostic markers into clinical use.

Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients

2021 ◽  
Vol 24 ◽  
pp. 141-147
Author(s):  
Asma Sabermahani ◽  
Mohammad Jafari Sirizi ◽  
Farzaneh Zolala ◽  
Sonia Nazari
Keyword(s):  
Indirect Costs ◽  
Out Of Pocket Costs

scholarly journals SWK-11. ASSESSMENT OF THE INDIRECT COSTS ASSOCIATED WITH PROTON THERAPY TREATMENT FOR ALBERTA PATIENTS REFERRED OUT OF COUNTRY

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii466-iii466
Author(s):  
Karina Black ◽  
Jackie Middleton ◽  
Sunita Ghosh ◽  
David Eisenstat ◽  
Samor Patel
Keyword(s):  
United States ◽  
Proton Therapy ◽  
Malignant Tumors ◽  
Indirect Costs ◽  
The United States ◽  
Current Data ◽  
Opportunity Costs ◽  
Proton Treatment ◽  
Out Of Pocket Expenses ◽  
The Cost

Abstract BACKGROUND Proton therapy for benign and malignant tumors has dosimetric and clinical advantages over photon therapy. Patients in Alberta, Canada are referred to the United States for proton treatment. The Alberta Heath Care Insurance Plan (AHCIP) pays for the proton treatment and the cost of flights to and from the United States (direct costs). This study aimed to determine the out-of-pocket expenses incurred by patients or their families (indirect costs). METHODS Invitation letters linked to an electronic survey were mailed to patients treated with protons between 2008 and 2018. Expenses for flights for other family members, accommodations, transportation, food, passports, insurance, and opportunity costs including lost wages and productivity were measured. RESULTS Fifty-nine invitation letters were mailed. Seventeen surveys were completed (28.8% response rate). One paper survey was mailed at participant request. Nine respondents were from parent/guardian, 8 from patients. All patients were accompanied to the US by a family member/friend. Considerable variability in costs and reimbursements were reported. Many of the accompanying family/friends had to miss work; only 3 patients themselves reported missed work. Time away from work varied, and varied as to whether it was paid or unpaid time off. CONCLUSIONS Respondents incurred indirect monetary and opportunity costs which were not covered by AHCIP when traveling out of country for proton therapy. Prospective studies could help provide current data minimizing recall bias. These data may be helpful for administrators in assessing the societal cost of out-of-country referral of patients for proton therapy.

PND21 A Tool Proposal For Measuring Costs Using Time-Driven Activity-Based Costing For The Ischemic Stroke Care Pathway

2021 ◽  
Vol 24 ◽  
pp. S162
Author(s):  
A.P. Etges ◽  
L. Ogliari ◽  
J.S. Souza ◽  
B. Zanotto ◽  
Cardoso R Bertoglio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Care Pathway ◽  
Stroke Care ◽  
Activity Based Costing

scholarly journals Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study

2021 ◽  
Vol 11 (6) ◽  
pp. 689
Author(s):  
Stefan Strilciuc ◽  
Diana Alecsandra Grad ◽  
Vlad Mixich ◽  
Adina Stan ◽  
Anca Dana Buzoianu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Indirect Costs ◽  
First Year ◽  
Hospital Level ◽  
Economic Burden Of Disease ◽  
Outpatient Cost ◽  
Patient Pathways ◽  
Stroke Disability ◽  
Access To Data ◽  
The Cost

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.

Abstract TP322: Additional Factors May Affect Hospital Performance Ratings on Ischemic Stroke Care in California

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Limin Wang ◽  
Merry Holliday-Hanson ◽  
Joseph Parker
Keyword(s):  
Ischemic Stroke ◽  
Geographic Location ◽  
Stroke Care ◽  
Hospital Performance ◽  
Performance Ratings ◽  
Tissue Type ◽  
Stroke Severity ◽  
Discharge Data ◽  
Insurance Type ◽  
Hospital Characteristics

Objectives: A report on ischemic stroke care at California hospitals was based on risk-adjusted 30-day mortality and accounted for many important risk factors (patient demography, clinical characteristics, and stroke severity). Other studies have indicated that geographic location, hospital characteristics and insurance type may also be drivers of differences in quality of care. The effect that these and other factors may have on hospital performance ratings for ischemic stroke is not well understood. Methods: Data used were from the California patient discharge data 2011-2013, collected by the Office of Statewide Health Planning and Development (OSHPD). Hospitals were chosen according to their performance in two recent hospital “report cards” on stroke produced by OSHPD. We compared 15 hospitals rated as “Better” with 14 “Worse” hospitals (10615 patients) on patient demographics, geographic location, insurance type, hospital characteristics, tissue-type plasminogen activator (tPA) use and expected 30-day mortality rate. Results: Patients admitted to “Worse” hospitals were more likely to be younger, white or Hispanic, and reside in lower income zip codes than “Better” hospitals ( P <0.001). “Worse” hospitals served a significantly higher percentage of patients with Medi-Cal insurance than “Better” hospitals (14.4% vs 9.6%, P <0.001). There were no significant differences in hospital geography or teaching status, bed size or Get With the Guidelines-Stroke Hospitals status between “Worse” and “Better” hospitals. Patients admitted to “Worse” hospitals had similar lengths of stay as those at “Better” hospitals and the transfer rate was also similar. “Worse” hospitals coded significantly fewer secondary diagnoses compared to “Better” hospitals (40.5% vs 53.0%, P <0.005). The tPA usage rate was significantly higher in the “worse” group than the “Better” group (11.5% vs 9.2%, P <0.005). “Worse” hospitals had significantly lower expected 30-day mortality rates compared to “Better” hospitals (8.8% vs 11.6%, P <0.005). Conclusion: Hospital performance ratings on ischemic stroke outcome were significantly associated with patient geographic location, socioeconomic status, and insurance type, but were not related to hospital characteristics.

Cost-Effectiveness of a Shared-Management Delivery System for the Care of Children with Cancer

PEDIATRICS ◽  
1980 ◽  
Vol 66 (6) ◽  
pp. 907-911
Author(s):  
Faye Strayer ◽  
C. Thomas Kisker ◽  
Carol Fethke
Keyword(s):  
Delivery System ◽  
Outpatient Care ◽  
Care Delivery ◽  
Indirect Costs ◽  
Alternative Methods ◽  
Shared Management ◽  
Pediatric Cancer Patients ◽  
Lost Productivity ◽  
Primary Physicians ◽  
Out Of Pocket Expenses

Costs of two alternative methods for obtaining comparable quality outpatient care for pediatric cancer patients were examined. Costs incurred in obtaining care from specialists, "specialist-management," were compared to costs incurred in obtaining "shared-management," care provided by specialists and primary physicians combined. Shared-management medical costs for outpatient care were 10% less than they would have been had the care been obtained from specialists. The nonmedical costs of transportation, parking, food away from home, and lost productivity or income were all less under the shared-management medical care delivery system than they would have been had specialist management been utilized. The total estimated cost differences between the alternative systems for the delivery of outpatient care ($2,191.34) represents for shared management a mean saving per patient of approximately 29% in direct out-of-pocket expenses and a 59% savings in the indirect costs of lost income or productivity. A total theoretical mean 41% saving per patient was shown to accrue through the use of shared management.

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