William S Bayliss1, Cheryl D Bushnell2, Jacqueline R Halladay3, Pamela W Duncan3, Janet K Freburger4, Anna M Kucharska-Newton5,6, Justin G Trogdon1. 1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill. 2. Department of Neurology, Wake Forest School of Medicine, Winston Salem. 3. Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. 4. Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, Pittsburgh, PA. 5. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. 6. Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY.
Abstract
BACKGROUND: The COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged home, was tested against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. This study examined the hospital-level costs associated with implementing and sustaining COMPASS. METHODS: Using an activity-based costing survey, we estimated hospital-level resource costs spent on COMPASS-related activities during approximately 1 year. We identified hospitals that were actively engaged in COMPASS during the year before the survey and collected resource cost estimates from 22 hospitals. We used median wage data from the Bureau of Labor Statistics and COMPASS enrollment data to estimate the hospital-level costs per COMPASS enrollee. RESULTS: Between November 2017 and March 2019, 1582 patients received the COMPASS intervention across the 22 hospitals included in this analysis. Average annual hospital-level COMPASS costs were $2861 per patient (25th percentile: $735; 75th percentile: $3,475). Having 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient (P=0.016). About half (N=10) of hospitals reported postacute clinic visits as their highest-cost activity, while a third (N=7) reported case ascertainment (ie, identifying eligible patients) as their highest-cost activity. CONCLUSIONS: We found that the costs of implementing COMPASS varied across hospitals. On average, hospitals with higher stroke volume and higher enrollment reported lower costs per patient. Based on average costs of COMPASS and readmissions for stroke patients, COMPASS could lower net costs if the model is able to prevent about 6 readmissions per year.
BACKGROUND: The COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged home, was tested against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. This study examined the hospital-level costs associated with implementing and sustaining COMPASS. METHODS: Using an activity-based costing survey, we estimated hospital-level resource costs spent on COMPASS-related activities during approximately 1 year. We identified hospitals that were actively engaged in COMPASS during the year before the survey and collected resource cost estimates from 22 hospitals. We used median wage data from the Bureau of Labor Statistics and COMPASS enrollment data to estimate the hospital-level costs per COMPASS enrollee. RESULTS: Between November 2017 and March 2019, 1582 patients received the COMPASS intervention across the 22 hospitals included in this analysis. Average annual hospital-level COMPASS costs were $2861 per patient (25th percentile: $735; 75th percentile: $3,475). Having 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient (P=0.016). About half (N=10) of hospitals reported postacute clinic visits as their highest-cost activity, while a third (N=7) reported case ascertainment (ie, identifying eligible patients) as their highest-cost activity. CONCLUSIONS: We found that the costs of implementing COMPASS varied across hospitals. On average, hospitals with higher stroke volume and higher enrollment reported lower costs per patient. Based on average costs of COMPASS and readmissions for stroke patients, COMPASS could lower net costs if the model is able to prevent about 6 readmissions per year.
Authors: Pamela W Duncan; Cheryl D Bushnell; Sara B Jones; Matthew A Psioda; Sabina B Gesell; Ralph B D'Agostino; Mysha E Sissine; Sylvia W Coleman; Anna M Johnson; Blair F Barton-Percival; Janet Prvu-Bettger; Adrienne G Calhoun; Doyle M Cummings; Janet K Freburger; Jacqueline R Halladay; Anna M Kucharska-Newton; Gladys Lundy-Lamm; Barbara J Lutz; Laurie H Mettam; Amy M Pastva; James G Xenakis; Walter T Ambrosius; Meghan D Radman; Betsy Vetter; Wayne D Rosamond Journal: Circ Cardiovasc Qual Outcomes Date: 2020-06-01
Authors: Janet Prvu Bettger; Karen P Alexander; Rowena J Dolor; DaiWai M Olson; Amy S Kendrick; Liz Wing; Remy R Coeytaux; Carmelo Graffagnino; Pamela W Duncan Journal: Ann Intern Med Date: 2012-09-18 Impact factor: 25.391
Authors: Cheryl D Bushnell; Pamela W Duncan; Sarah L Lycan; Christina N Condon; Amy M Pastva; Barbara J Lutz; Jacqueline R Halladay; Doyle M Cummings; Martinson K Arnan; Sara B Jones; Mysha E Sissine; Sylvia W Coleman; Anna M Johnson; Sabina B Gesell; Laurie H Mettam; Janet K Freburger; Blair Barton-Percival; Karen M Taylor; Janet Prvu-Bettger; Gladys Lundy-Lamm; Wayne D Rosamond Journal: J Am Geriatr Soc Date: 2018-03-23 Impact factor: 7.538
Authors: Arvind B Bambhroliya; John P Donnelly; Eric J Thomas; Jon E Tyson; Charles C Miller; Louise D McCullough; Sean I Savitz; Farhaan S Vahidy Journal: JAMA Netw Open Date: 2018-08-03