There a fairly steady stream of occasional articles describing the evolution of stroke care in the U.S. These are typically pieces praising improvements tied to “Get With The Guidlines-Stroke”, describing decreases in overall stroke mortality, and the like. “Never better!” would probably be how most neurologists describe the current state of stroke care.
These impressions might be a bit of a rose-colored view of the elephant. This is just a simple descriptive analysis in trends for stroke, TIA, and ICH care in U.S. emergency departments and hospitals from 2006 until 2014. A couple things of curiosity and/or concern stand out:
- Annual in-hospital mortality from stroke has declined from ~5.8% to ~4.4%. This looks good until it’s noted annual total stroke admissions increased from 353,000 to 415,000. So, in an absolute sense, mortality hasn’t changed much – we’ve probably just been adding additional cases that wouldn’t otherwise have been diagnosed as stroke.
- Costs of hospitalization for all diagnoses have almost doubled. For stroke, hospitalization charges have risen from a mean of $27,000 to $48,000. I’d love to chalk up the cost increase solely to the accompany increased frequency of use of our favorite clot-buster, but the relative cost increases are similar for TIA, as well.
The overall gist I get from these data is the value, overall, of our care for acute neurologic emergencies is diminishing. I’m certain we’re doing a much better job of post-stroke care these days for those who would truly benefit, but clearly we’re also sinking a lot more money into an expanding population where the average benefit is probably lower. It’s shaping up to be an interesting race to see which aspect of healthcare can bankrupt our economy first.
“National trends in stroke and TIA care in U.S. emergency departments and inpatient hospitalizations”
https://www.ajemjournal.com/article/S0735-6757(18)30648-X/fulltext
This illustrates the problem with medicine and its reliance on trend analysis and not analytics. The sepsis data is the same with very high cost for some benefit.
Agreed – although whether the ignorance is innocent or purposeful is another matter for debate.
In my current institution, the expansion of neuro-interventional has resulted in a whole messload of vascular imaging (CTAs) as part of the “code stroke” workup, in an effort to identify cases early and free up the MRI machine by avoiding the MRA portion. This mean that “soft” stroke codes are getting unnecessary CTAs. I’m sure this increase costs with no benefit to patient care.