title: Clinical efficiency tools improve stroke management in a rural southern health system.
abstract: OBJECTIVE
  Ischemic stroke is a high-volume and financially draining diagnosis at this rural health system. The purpose of this clinical practice analysis was to identify resource utilization and clinical process inefficiencies and to promote clinically efficient, evidence-based improvements.
  
  
  METHODS
  A retrospective analysis of medical record and financial databases of 356 patients with ischemic stroke was performed. The medical record data were adjusted for severity, and outliers were eliminated. The resources utilized by each physician were determined. Comparative graphs were prepared, presented, and discussed. The physicians implemented two types of changes: (1) alteration of resource utilization and consultation patterns and (2) support of clinical process improvement. In 1997, a follow-up analysis of 399 patients was performed.
  
  
  RESULTS
  The initial comparison of internists' to neurologists' patient populations found the following: patient age (75 versus 65 years), patient severity ratings (2.8 versus 2.5), length of stay (10.7 versus 8.8 days), costs ($7360 versus $6862), mortality rates (12.5% versus 8.9%), and aspiration pneumonia rate (8.5% versus 3.8%). A comparison of the 1995 analysis to the 1997 analysis revealed the following per patient resource utilization decreases (all P < 0.05): chemistry laboratory, 2.65 to 1.95 studies; intravenous fluids, 2.85 to 1.85 L; oxygen use, 6.06 to 2.75 U; and nifedipine use, 1.62 to 0.33 capsules. The clinical process improvements resulted in the following overall outcomes (all P < 0.05 except mortality): length of stay (7.2 days), nonadjusted costs ($6246), mortality (6.5%), and rates of pneumonia (2.7%).
  
  
  CONCLUSIONS
  Objective analysis of resource utilization resulted in physicians changing their individual management of stroke and collectively supporting clinical process changes that improved clinical and financial outcomes.
authors.affiliation: Tupelo Neurology Clinic, Miss., USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Newell
authors.forename: J
authors.initials: J
authors.lastname: Englert
authors.forename: A
authors.initials: A
authors.lastname: Box-Taylor
authors.forename: K M
authors.initials: KM
authors.lastname: Davis
authors.forename: K E
authors.initials: KE
authors.lastname: Koch
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D002545:Brain Ischemia / Q000191:economics / Q000401:mortality / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000191:economics / Q000401:mortality / Q000628:therapy*; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008922:Mississippi; D009462:Neurology / Q000592:standards*; D010820:Physicians / Q000523:psychology / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data*