title: Analysis of the costs and payments of a coordinated stroke center and regional stroke network.
abstract: OBJECTIVE
  An earlier study demonstrated significantly improved access, treatment, and outcomes after the implementation of a progressive, comprehensive stroke program at a tertiary care community hospital, Saint Luke's Neuroscience Institute (SLNI). This study evaluated the costs associated with implementing such a program.
  
  
  METHODS
  Retrospective analysis of total hospital costs and payments for treating patients with ischemic stroke at SLNI (n=1570) as program enhancement evolved over time (2005, 2007, and 2010) and compared with published national estimates. Analyses were stratified by patient demographic characteristics, patient outcomes, treatments, time, and comorbidities.
  
  
  RESULTS
  Controlling for inflation, there was no difference in SLNI total costs between 2005 and either 2007 or 2010, suggesting that while SLNI provided an increased level of services, any additional expenditures were offset by efficiencies. SLNI total costs were slightly lower than published benchmarks. Consistent with previous stroke care cost estimates, the median overall differential between total hospital costs and payments for all ischemic stroke cases was negative.
  
  
  CONCLUSIONS
  SLNI total costs remained consistent over time and were slightly lower than previously published estimates, suggesting that a focused, streamlined stroke program can be implemented without a significant economic impact. This finding further demonstrates that providing comprehensive stroke care with improved access and treatment may be financially feasible for other hospitals.
authors.affiliation: Saint Luke's Neuroscience Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO 64111, USA. mrymer@saint-lukes.org
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
authors.forename: Neil R
authors.initials: NR
authors.lastname: Meredith
authors.forename: Sissi V
authors.initials: SV
authors.lastname: Pham
authors.forename: Kevin
authors.initials: K
authors.lastname: Thorpe
authors.forename: Denise T
authors.initials: DT
authors.lastname: Kruzikas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000191:economics* / Q000628:therapy; D003365:Costs and Cost Analysis; D005260:Female; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000628:therapy; D062606:Tertiary Care Centers / Q000191:economics* / Q000592:standards
keywords: cost; guidelines; stroke; thrombolytic; tissue-type plasminogen activator