Rationale and Design of a Statewide Cohort to examine efficient resource utilization for patients with Intracerebral hemorrhage (EnRICH)

Abstract

BackgroundIntracerebral hemorrhage is a devastating disease with no specific treatment modalities. A significant proportion of patients with intracerebral hemorrhage are transferred to large stroke treatment centers, such as Comprehensive Stroke Centers, because of perceived need for higher level of care. However, evidence of improvement in patient-centered outcomes for these patients treated at larger stroke treatment centers as compared to community hospitals is lacking.Methods / design“Efficient Resource Utilization for Patients with Intracerebral Hemorrhage (EnRICH)” is a prospective, multisite, state-wide, cohort study designed to assess the impact of level of care on long-term patient-centered outcomes for patients with primary / non-traumatic intracerebral hemorrhage. The study is funded by the Texas state legislature via the Lone Star Stroke Research Consortium. It is being implemented via major hub hospitals in large metropolitan cities across the state of Texas. Each hub has an extensive network of “spoke” hospitals, which are connected to the hub via traditional clinical and administrative arrangements, or by telemedicine technologies. This infrastructure provides a unique opportunity to track outcomes for intracerebral hemorrhage patients managed across a health system at various levels of care. Eligible patients are enrolled during hospitalization and are followed for functional, quality of life, cognitive, resource utilization, and dependency outcomes at 30 and 90 days post discharge. As a secondary aim, an economic analysis of the incremental cost-effectiveness of treating intracerebral hemorrhage patients at higher levels of care will be conducted.DiscussionFindings from EnRICH will provide much needed evidence of the effectiveness and efficiency of regionalized care for intracerebral hemorrhage patients. Such evidence is required to inform policy and streamline clinical decision-making.

The Effect of Telemedicine Consultation on Outcomes in Patients with Intracerebral Hemorrhage

“…На сегодняшний день недостаточно доказательств, которые могли бы установить критерии для перевода пациентов с ВМК на следующий этап оказания медицинской помощи. Текущие рекомендации предусматривают чрезвычайно широкие и неточные параметры [9]. Необходимы дальнейшие рандомизированные клинические исследования с применением телемедицинских технологий для уточнения показаний для перевода больных с ВМК в медицинские организации следующего уровня.…”

High in-hospital blood pressure variability and severe disability or death in primary intracerebral hemorrhage patients

“…Detailed rationale and design of EnRICH has been previously described. 7 Briefly, EnRICH is a prospective, multi-site, state-wide cohort designed to assess the comparativeeffectiveness of ICH management at Comprehensive Stroke Certified (CSC) centers, relative to ICH management at Primary Stroke Certified (PSC) or other/ non-certified hospitals. Enrollment began in September 2016 and is currently ongoing at four major metropolitan hubs in the state of Texas (Houston, Austin, San Antonio, and Dallas).…”

Resource utilisation among patients transferred for intracerebral haemorrhage

“…However, transfers are costly to the healthcare system, as well as to patients and families that must travel farther from their home to the location of care. While many transfers are likely cost-effective from the societal perspective overall,3 data on the cost-effectiveness of ICH patient transfer are limited and conflicting 4. One study reported large differences in costs for gains in quality-adjusted life years depending on patient scenarios,3 and another failed to demonstrate the cost-effectiveness of transfer for these patients 5.…”

“…If safe, identification of patients for whom transfer could be avoided would be satisfying to patients and their families, as well as to payers and the healthcare system as a whole. In order to achieve such efficiency, we must consider how to identify the subset of patients for whom transfer could be avoided—there is currently little evidence to inform this decision 4. Our primary objective was to identify factors associated with resource utilisation among patients admitted for ICH.…”