Study: These quality measures for stroke care improved ‘value’ for patients the most

Of the 15 process measures endorsed by national health care associations, just five of them contributed to the most improvements in care, a new study from Vanderbilt University Medical Center researchers has found.

The study, a cost-effectiveness analysis published in early May in the Annals of Internal Medicine and led by Assistant Professor of Health Policy Jinyi Zhu, PhD, found that five measures, such as early carotid imaging and intravenous tissue plasminogen activator (tPA), accounted for 92% of the total value of quality improvement among all measures. These five measures effectively enhance health outcomes for patients at a small cost, by signficantly extending their lives or improving their quality of life.   

portrait of jinyi zhu, phd

“Cost-effectiveness analysis is a powerful tool to help us systematically weigh the tradeoffs between health benefits and costs,” said Zhu. “By identifying the most valuable measures for improving the quality of acute ischemic stroke care, our study demonstrates the importance of using this approach in health decision-making.”

Zhu and her collaborators at Harvard and Cornell universities found using simulation models that five of the 10 quantifiable quality measures outperformed others in terms of total value, measured in this study by (quality-adjusted) life-years gained and incremental total lifetime cost. The remaining five measures could not be evaluated quantitatively, lacking enough clinical evidence to do so.

The most valuable quality measure in terms of total cost and net health benefit was early carotid imaging, researchers found. Improvement in this measure was found to be highly cost-effective and would benefit a large number of stroke patients. If achieved at 100% implementation, it could produce an estimated net gain of $1.08 billion per year across the large study sample.

The quality measures have been endorsed by the American Stroke Association and American Heart Association to improve quality of care. Setting targets can help clinicians prioritize quality of care efforts, though it was largely unknown which, if any, performed better in terms of value.

“Our study aims to guide clinicians and policy makers in prioritizing which quality measures to focus on when designing initiatives to improve stroke care,” Zhu said. “By targeting the few of the most valuable measures like carotid imaging and use of tPA, we can have a greater impact on patient health outcomes while minimizing the associated costs.”

The study was funded by a grant from the National Institute of Neurological Disorders and Stroke.