Redirecting Patients to Improve Stroke Outcomes: Implications of a Volume-Based Approach in One Urban Market

By | February 1, 2007

In the December issue of Medical Care, Center members Dr. Randall Cebul & Mark E. Votruba, PhD, investigate whether better health outcomes could be expected if stroke patients were directed to hospitals treating higher volumes of stroke patients. Using data from 12,150 Medicare patients admitted for acute stroke to one of 29 hospitals in Greater Cleveland, the authors find that hospital stroke volume is predictive of lower 30-day (risk-adjusted) mortality rates, but that patient distance to nearest hospital is predictive of higher mortality rates. Simulating the effect of hypothetical policies to direct stroke patients exclusively to hospitals meeting a particular volume threshold, they find that potential improvements in mortality are largely offset by the adverse effect of increasing patient-hospital distance. This finding sheds doubt on the value of implementing volume-based referral policies for hospital stroke care. (posted 2/2007) Medical Care, Dr. Randall Cebul