London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 475 357 Management and economics Quality parameters of acute stroke care in structurally different settings in four populous re-gions of Germany J. Eyding1, D. Bartig2, C. Krogias3, P. Mueller-Barna4, R. Weber5, M. Kitzrow6 Dpt. Neurology, Knappschaftskrankenhaus, Ruhr University, Bochum, GERMANY1, drg mar-ket, Osnabrueck, GERMANY2, Dpt. Neurology, St. Josef-Hospital, Ruhr University, Bochum, GER-MANY3, Dpt. Neurology, Municipal Hospital Harlaching, Munich, GERMANY4, Dpt. Neurology, Alfried Krupp Hospital, Essen, GERMANY5, Dpt. Neurology, Bergmannsheil, Ruhr University, Bo-chum, GERMANY6 Background Specialized care on a stroke unit and iv thrombolysis within certain time limits are evident factors of a positive course in acute stroke. Therefore, various attempts are taken to optimize acute stroke care in accordance to regional requirements. Broad access to upcoming interventional recanalization therapies strongly depends on optimized region-wide organization of patients´ flow. Methods Data analysis of DRG statistics of 2008/2011 for depiction of quality of routine treatment. Aggrega-tion of number of cases for rate of stroke-unit treatment, iv thrombolysis, and neurothrombectomy in four populous regions of Germany with regionally different structured stroke care. Results In the metropolitan Ruhr area, a network of 27 neurological stroke units was founded in 2010. In the metropolis of Berlin, an alliance of 40 institutions of acute, rehab, and postrehab stroke patient care was built in 2008. In the territorial region of East-Westfalia/Lippe (EWL), there is no specific stroke network, yet 7 large neurological stroke units are covering patient care. In the rural region of South-eastern Bavaria (SEB), a network of 15 stroke units partly attached to internal medicine departments are tele-medically provided 24/7 by two stroke centres (TEMPiS). Discussion Regionally as well as locally structured care of acute stroke seem to influence quality parameters. Rate of thrombolysis in 2011 was highest in EWL and SEB, where either large and powerful neuro-logical stroke units provide patient care, or a dedicated region-wide concept of stroke care has been established. In the Ruhr area, parameters were inhomogeneous with a clear-cut emphasis on neu-rothrombectomy, one of the dedicated aims of the network. To further optimize established quality parameters of stroke care, we propose that, besides established actions like public awareness cam-paigns, regionally consented concepts of acute stroke care should be established comprehensively. 358 Management and economics The societal cost of stroke in Sweden 2009 and developments since 1997 O. Ghatnekar1, E-L. Glader2, U. Persson3, K. Asplund4 Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWEDEN1, De-partment of Public Health and Clinical Medicine, Umeå University, Umeå, SWEDEN2, Swedish Institute for Health Economics, Lund, SWEDEN3, Department of Public Health and Clinical Medi-cine, Umeå University, Umeå, SWEDEN4 Background The cost of stroke is not limited to the acute hospital phase and may extend throughout the rest of the patient’s life. In 1997 the lifetime cost for a stroke patient was estimated to €78,400 in a life-time perspective (year 2009 prices). Stroke care in Sweden has developed since then and this study aims at measure its impact on costs. Methods Resource data for first-ever stroke patients was taken from annual reports from Riks-Stroke, the Swedish national quality registry for stroke care. Resources included living conditions and home assistance before and 3 months after stroke, ambulance transport, hospital length of stay, rehabilita-tion, follow-up visits, secondary drug prevention and production losses. Age-specific survival rates were extrapolated based on literature. Unit costs were taken from official sources (2009 prices) and an annual discount rate of 3% was applied. Results About 21,800 persons suffered their first stroke in 2009 (233/100,000) with a mean age of 76. The present value of a stroke, i.e. including costs for rest of life sequelae, amounted to €69,800 per pa-tient, or a societal cost of €1.5 billion for all first-ever strokes. Increased municipality care due to impairments after the stroke constituted 40% of total costs followed by production losses (34%) al-though only 20% of the patients were in productive age. Acute hospital costs accounted for 18% and the reminding 8% was rehabilitation, other outpatient visits and drugs. Compared to 1997 the acute hospital cost did not change (shorter stay at higher per diem cost). The emphasis on intensive acute treatment and rehabilitation (+14%) may explain some of the reduced cost for municipality care and home support (-51%) due to reduced impairments in the first year. Conclusion Developments in Swedish stroke care and patient characteristics during the 2000’s have had an im-pact on both the level and the structure of the costs. In spite of a greater number of strokes, the total cost has not changed.
Karger_ESC London_2013
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