When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic...

Area of Science:

• Health Services Research
• Clinical Outcomes Research
• Healthcare Management

Background:

• Transient ischaemic attack (TIA) services are crucial for preventing subsequent strokes.
• Optimizing TIA service delivery is essential for improving patient outcomes and managing healthcare costs.

Purpose of the Study:

• To evaluate the impact of modifying transient ischaemic attack (TIA) services on healthcare costs and clinical outcomes in two hospital settings.
• To assess the effectiveness of different TIA service configurations in meeting national targets for patient care.

Main Methods:

• A discrete event simulation model was developed using electronic health record data from 2011.
• The model analyzed patient pathways from symptom onset through TIA diagnosis, treatment, and subsequent stroke risk.
• Interventions included comparing existing services with previous models and hypothetical reconfigurations, such as a 7-day service.

Main Results:

• Service reconfiguration improved the proportion of high-risk patients seen within 24 hours from 31% to 79%.
• Median time to clinic attendance decreased from 1.15 days to 0.85 days.
• While costs varied slightly between sites, there was no significant reduction in the modelled incidence of major stroke.

Conclusions:

• Modifying TIA services effectively increases the attainment of national care targets.
• For TIA services already operating efficiently (1-2 day treatment times), further reconfiguration shows minimal impact on clinical outcomes.
• Increased investment in optimizing highly efficient TIA services may not yield significant clinical benefits or be cost-effective.