22. European Stroke Conference 367 Management and economics Accountability for Stroke Care Across the Continuum: Who’s Responsibility is it?? M.P. Lindsay1, M. Suddes2, L. Kelloway3, L. Nichol4, I. Joiner5, G. Gubitz6, T.L. Green7 Canadian Stroke Network, University of Toronto, Ottawa, CANADA1, Calgary Stroke Program, Calgary, CANADA2, Ontario Stroke Network, Toronto, CANADA3, Winnipeg Regional Health Au-thority, Winnipeg, CANADA4, Heart and Stroke Foundation of Canada, Ottawa, CANADA5, Dal-housie University, Halifax, CANADA6, University of Calgary, Ca;gary, CANADA7 Background: Evidence-based practice guidelines (BPGs) provide a structured means of ensuring care is consistent among stroke teams and across settings. Uptake of BPGs at point of care has a measurable impact on processes and patient outcomes. Our goal is to enhance stroke quality and evaluation frameworks to be responsive to system issues, and demonstrate the impact of individual healthcare professions on process and outcome measures. Methods: Using Delphi-methodology with 10 expert panel members, a subset of the Canadian Best Practice Recommendations for Stroke Care (CBPRSC) were identified as clearly actionable by members of stroke teams. An online survey was conducted from October to December 2012 to ex-plore: i) the positions/roles with primary responsibility for implementation of CBPRSC (e.g. fund-ing, equipment, organization, training); ii) the relative contribution of health disciplines in applying stroke best practices at a patient level; and, iii) implications for performance measurement and qual-ity improvement. Links to the survey were sent to healthcare professionals involved in stroke care across Canada through a spider-web model. Results: A total of 428 surveys were completed by individuals representing 20 health disciplines in settings all across the continuum. More than 70% of participants had greater than 10 years ex-perience working in stroke care. Implementation of System level recommendations was most of-ten attributed to stroke neurologists and managers, and patient-level recommendations attributed to nursing and allied health. Consistency was found in the assignment of responsibility for several rec-ommendations. 480 © 2013 S. Karger AG, Basel Scientific Programme Conclusions: In a system focused on quality and accountability, attributing evidence-based care stroke processes and outcomes to specific disciplines will enhance continuity of care, streamline team functioning, focus education, and enable providers to demonstrate value, resulting in increased success at meeting patient and family care needs. 368 Management and economics COST/BENEFIT ANALYSIS OF THROMBOLYTIC TREATMENT OF ACUTE ISCHEMIC STROKE IN A HUNGARIAN STROKE CENTER A. FOLYOVICH1, E. Molnár2, K.A. Béres-Molnár3, V. Varga4, K. Vadasdi5, A. Póth6, N. Kaszás7 Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY1, Depart-ment of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY2, Department of Neu-rology and Stroke, Szent János Hospital, Budapest, HUNGARY3, Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY4, Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY5, Department of Statistics, Szent János Hospital, Budapest, HUNGARY6, Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY7 Background: Thrombolytic treatment (TT) of acute ischemic stroke (AIS) can be safely performed in institutions with 24-hour availability of all medical disciplines. In Hungary, the National Health Insurance Fund (OEP) provides an uniform financing for TT, irrespective of the characteristics of the institute. There is no differential financing for TT, even if it is performed in an institutions with a higher financial demand. Immediate costs of TT are higher than those of the treatment of stroke patient who are not eligible for TT. However, TT is more cost-effective in the long term, as residual symptoms occur 30% less often after TT. Patients and methods: Based on financing by OEP, we performed an analysis of the financing and costs of care of stroke patients with and without TT. The latter was compared to the monthly addi-tional cost of the care of a patient disabled due to stroke. We examined the financial demand of TT in our Stroke Center, which is a department of a big hospital. Results: OEP provides 4,922 times more money for TT, than for the care of an „average” stroke pa-tient. The absolute difference of the two amounts equals to two months of additional costs for a dis-abled patient. Between 2009-2011, 51.5% of acute neurological patients were admitted to our cen-ter during on-call duty hours (with availability of all resources). In case of TT, this percentage was 66.66%. The results justified the higher costs: average NIHSS score of patients with TT at the time of admission decreased by 14% by the time of discharge (by 18% in patients under 65 years of age), and by 9% in non-treated patients. Score of the modified Rankin Scale (mRS) was 16% lower in pa-tients with TT (29% under 65 years), and 6% lower in non-treated patients (5,3% under 65 years). Conclusion: TT in AIS has a proven benefit both in a medical and an economical sense. All mea-sures that make thrombolysis more accesible are advantageous both for the individual and the soci-ety.
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