Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health’s benchmark

Abstract

BackgroundSince the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed.AimsThis study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization.MethodsA retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal–Wallis test with Dunn’s post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators.ResultsData from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient’s stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001).ConclusionThe stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy.

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil

“…This timeframe is consistent with data from European registries, which reported a mean time of 70 min [30]. Despite the increase in thrombolysis frequency post-SU implementation (6.1% to 10.8%), it remained relatively low, underscoring the ongoing need to strengthen the stroke survival chain [29]. However, this is similar to the reality in northern and southern European countries, where only 7.3% of all AIS patients receive thrombolysis, reflecting an unequal geographical SU distribution [31].…”

“…Furthermore, the number of thrombolysis patients within <60 min post-SU implementation increased from 7 to 25. Although modest, these findings parallel those of a study conducted in Botucatu (SP), which also identified a small number of patients undergoing thrombolytic treatments with door-to-needle times <60 min [29]. This timeframe is consistent with data from European registries, which reported a mean time of 70 min [30].…”

“…Aligned with the Brazilian Ministry of Health, this study demonstrates good adequacy levels for quality indicators of in-hospital care, affirming the ongoing relevance of continuous monitoring. However, Brazil still faces a lack of investment in SUs [29]. Despite this, Brazil, a middle-income country in the Americas, stands out due to its standardized care consolidated through national health policies in stroke treatment outlined by the WHO.…”