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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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High-Value Care in the Evaluation of Stroke
Prakrity Urja1, Eric H Nippoldt2, Virginia Barak2
1Creighton University Medical Center, CHI Creighton University.
Cureus
|October 7, 2017
Summary
This case highlights how repeating diagnostic tests like hypercoagulable evaluations and transesophageal echocardiograms (TEE) may not align with value-based care principles for stroke patients. Such repeat testing may not alter treatment or improve outcomes, questioning its utility and resource allocation.
Area of Science:
- Neurology
- Cardiology
- Health Services Research
Background:
- Value-based care prioritizes maximizing health benefits per dollar spent.
- This case examines the application of value-based care principles in managing a complex stroke patient.
Observation:
- A 73-year-old patient with extensive cerebrovascular disease presented with acute stroke symptoms.
- Previous investigations included multiple embolic strokes, patent foramen ovale, and carotid artery occlusion.
- The patient had a history of intracranial hemorrhage while on anticoagulation for pulmonary embolism.
Findings:
- Repeat hypercoagulable evaluation and transesophageal echocardiogram (TEE) were considered in the context of a new stroke.
- Previous evaluations for hypercoagulable state were negative, and a repeat TEE showed a known patent foramen ovale without new findings.
- These repeat investigations did not alter the patient's treatment plan or management strategy.
Implications:
- Repeating diagnostic tests without altering management may not align with value-based care principles.
- Judicious use of investigations is crucial for reducing healthcare costs and optimizing resource allocation.
- Applying value-based care principles can lead to more efficient and effective patient care.
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