title: Impact of integrated cerebrovascular program on outcomes in patients with intracranial aneurysms.
abstract: BACKGROUND
  Recent evidence indicates that multidisciplinary care improves patient outcomes in cerebrovascular (CV) disease. A multidisciplinary integrated CV program was recently instituted at a high-volume tertiary referral center, providing the opportunity to evaluate patient outcomes before and after its introduction.
  
  
  OBJECTIVE
  To evaluate outcomes after treatment of patients with intracranial aneurysm in relation to the introduction of a CV program at our institution.
  
  
  METHODS
  A retrospective chart review was performed on all new patient encounters for a 6-month period each before and immediately after the introduction of the CV program, as well as at a more recent 6-month period to evaluate long-term results. Data were collected on demographic variables, rupture status, medical comorbidities, hospital complications, in-hospital procedures, hospital course and modified Rankin score at discharge and follow up.
  
  
  RESULTS
  The total number of patients treated increased from 55 in the 6-month period before the introduction of the CV program to 112 in the most recent time period (p<0.05). Both the surgical clipping and endovascular coiling procedures increased (p<0.05). A significant increase occurred in patients with multiple comorbidities (30.5% vs 34.7%, p=0.035). The mean length of stay decreased from 12.22 ± 13.26 days before the program to 9.23 ± 12.04 days in the most current data (p<0.05).
  
  
  CONCLUSIONS
  Creation of an integrated CV program at a large-volume tertiary referral center resulted in better outcomes for an increased number of more medically complicated patients with intracranial aneurysms. This study provides preliminary data for developing an integrated model of multidisciplinary care for the management of CV disease.
authors.affiliation: Division of Neurosurgery, Department of Neuroscience, Medical University of South Carolina, Charleston, South Carolina 29425, USA. krishna@musc.edu
authors.forename: Vibhor
authors.initials: V
authors.lastname: Krishna
authors.forename: Kelsey
authors.initials: K
authors.lastname: Walsh
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Turner
authors.forename: Julio
authors.initials: J
authors.lastname: Chalela
authors.forename: Aquilla
authors.initials: A
authors.lastname: Turk
authors.forename: Sunil J
authors.initials: SJ
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000628:therapy; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D016896:Treatment Outcome