GJJT

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Post-Acute Stroke Care
GJJT
Posted on May 1, 2017 at 11:48 pm
How to demonstrate value of a home-based, post-acute stroke care team?

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On May 13, 2017, GJJT commented on Post-Acute Stroke Care :

Thank you. We can certainly quantify the savings by freeing up MDs to see New Patients while the RNs are seeing patients at home.

On May 10, 2017, GJJT commented on Balancing Local and System Interests (Aren’t we on the same team?) :

I would consider establishing a Systemwide Committee with representation from community providers. Committee goals can include a dashboard (quality, process, financial, patient experience etc), establishment of pathways etc. This will begin dialogue between providers and campuses, hopefully lead to meaningful collaboration/shared learning, guided by data.

On May 10, 2017, GJJT commented on Post-Acute Stroke Care :

Thank you for your input.

On May 10, 2017, GJJT commented on Post-Acute Stroke Care :

We are collecting Stroke Impact Scale (SIS) which is a functional scale, Morisky medication adherence etc. Have not collected falls.

On May 3, 2017, GJJT commented on Post-Acute Stroke Care :

Thank you for your input. We are still working on some of the analytics and don’t have adequate ideal “controls” for many metrics as we didn’t prospectively randomize patients to Stroke Mobile or traditional care; this is the basis of a recent grant submission. We are using a blend of historical rates (when available), industry rates and are partnering with our major payor to compare our outcomes to patients treated at other facilities in our state.

The grant protocol was an in-home visit monthly for 12 months but we have modified that in the post-grant period to a blend of in-home and telephone visits. Our post-grant 30-day readmission rate is 6% and our BP control rate (average of any visit is 88%). To your point, data during the grant period indicate the major BP value occured by 90 days. I suspect reducing the intervention from 12 to 3 months is where we are headed.