Physical and rehabilitation medicine (PRM) care pathways: “Stroke patients”

Yelnik, A.; Schnitzler, A.; Pradat‐Diehl, Pascale; Sengler, J.; Devailly, J.-P.; Dehail, Patrick; D’Anjou, M.-C.; Rode, Gilles

doi:10.1016/j.rehab.2011.09.004

Cited by 22 publications

(6 citation statements)

References 14 publications

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“…However, our approach was consistent with previous health economic studies on stroke and/or thrombolysis in France and in the international literature. Indeed, the post-acute clinical pathways were defined based on the Ministry of Health's guidelines [6] and Fery-Lemonnier [8] report as well as on Yelnik et al [7]. French studies such as Launois et al [3] and Chevreul et al .…”

Section: Discussionmentioning

confidence: 99%

“…The post-acute phase corresponds to the period following discharge and up until 1 year. Five post-acute clinical care pathways were defined, using the Ministry of Health guidelines [6] and recommendations from the French Physical and Rehabilitative Medicine Society (SOFMER) and the French Federation of Physical and Rehabilitative Medicine (FEDMER) (hereafter referred to as Yelnik et al [7]). The post-acute phase pathways were the following (fig.…”

Section: Methodsmentioning

confidence: 99%

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Acute Ischemic Stroke (AIS) Patient Management in French Stroke Units and Impact Estimation of Thrombolysis on Care Pathways and Associated Costs

et al. 2015

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Background: Stroke is the second leading cause of death and a first leading cause of acquired disability in adults worldwide. This study aims to evaluate the current management and associated costs of acute ischemic stroke (AIS) for patients admitted in stroke units in France and over a one-year follow-up period as well as to assess the impact of improved thrombolytic management in terms of increasing the proportion of patients receiving thrombolysis and/or treated within 3 h from the onset of symptoms. Methods: A decision model was developed, which comprises two components: the first corresponding to the acute hospital management phase of patients with AIS up until hospital discharge, extracted from the national hospital discharge database (PMSI 2011), and the second corresponding to the post-acute (post-discharge) phase, based on national treatment guidelines and stroke experts' advice. Five post-acute clinical care pathways were defined. In-hospital mortality and mortality at 3 months post-discharge was taken into account into the model. Patient journeys and costs were determined for both phases. Improved thrombolytic management was modeled by increasing the proportion of patients receiving thrombolysis from the current estimated level of 16.7 to 25% as well as subsequently increasing the proportion of patients treated within 3 h of the onset of symptoms post-stroke from 50 to 100%. The impact on care pathways was derived from clinical data. Results: Among 202,078 hospitalizations for a stroke or a transient ischemic attack (TIA), 90,528 were for confirmed AIS, and 33% (29,999) of them managed within a stroke unit. After hospitalization, 60% of discharges were to home, 25% to rehabilitative care and then home, 2% to rehabilitative care and then a nursing home, 7% to long-term care, and 6% of stays ended with patient death. Of a total cost over 1 year of €610 million (mean cost per patient of €20,326), 70% concern the post-acute phase. By increasing the proportion of patients being thrombolyzed, costs are reduced primarily by a decrease in rehabilitative care, with savings per additional treated patient of €1,462. By adding improved timing, savings are more than doubled (€3,183 per additional treated patient). Conclusions: This study confirms that the burden of AIS in France is heavy. By improving thrombolytic management in stroke units, patient journeys through care pathways can be modified, with increased discharges home, a change in post-acute resource consumption and net savings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Acute Ischemic Stroke (AIS) Patient Management in French Stroke Units and Impact Estimation of Thrombolysis on Care Pathways and Associated Costs

et al. 2015

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“…The main coordination problems encountered after patient discharge from hospital were poor information transfer from hospital to downstream staff, on the one hand, and delays due to administrative procedures, on the other [51]. Solutions to such problems might be holistic initiatives such as, for instance, integrated PRM care pathways [6,52] and early supported discharge procedures which have been shown to reduce long-term dependency, admissions to institutional care facilities, and length of hospital stay, at least in a selected elderly group of stroke patients with moderate disability [53]. In summary, for a SCP to function well, health professionals need to collaborate closely.…”

Section: Discussionmentioning

confidence: 99%

Main barriers to effective implementation of stroke care pathways in France: a qualitative study

Gache

Leleu

Nitenberg

et al. 2014

BMC Health Serv Res

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BackgroundStroke Care Pathways (SCPs) aim to improve quality of care by providing better access to stroke units, rehabilitation centres, and home care for dependent patients. The objective of this study was to identify the main barriers to effective implementation of SCPs in France.MethodsWe selected 4 types of SCPs currently implemented in France that differed in terms of geographical location, population size, socio-economic conditions, and available health care facilities. We carried out 51 semi-structured interviews of 44 key health professionals involved in these SCPs and used the interview data to (i) create a typology of the organisational barriers to effective SCP implementation by axial coding, (ii) define barrier contents by vertical coding. The typology was validated by a panel of 15 stroke care professionals.ResultsFour main barriers to effective SCP implementation were identified: lack of resources (31/44 interviewees), coordination problems among staff (14/44) and among facilities (27/44), suboptimal professional and organisational practices (16/44), and inadequate public education about stroke (13/44). Transposition of the findings onto a generic SCP highlighted alternative care options and identified 10 to 17 barriers that could disrupt continuity of care.ConclusionLack of resources was considered to be the chief obstacle to effective SCP implementation. However, the main weakness of existing SCPs was poor communication and cooperation among health professionals and among facilities. We intend to use this knowledge to construct a robust set of quality indicators for use in SCP quality improvement initiatives, in comparisons between SCPs, and in the assessment of the effective implementation of clinical practice guidelines.

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“…14 In France, after initial care in a stroke unit (approximately 10 days), the patient may be discharged directly home or he or she may be sent for rehabilitation, which, in France, may be carried out in a neurological rehabilitation center (NRC) with specialized, coordinated rehabilitation or in a general or geriatric rehabilitation center (GRC). 15 In a previous study, we showed that in France, the vast majority of patients admitted for rehabilitation went to GRC. 16,17 Older patients with a severe initial impairment and those with cognitive impairments tend to be more frequently admitted to GRC.…”

Section: Introductionmentioning

confidence: 93%