The Cost of Implementing and Sustaining the COMprehensive Post-Acute Stroke Services Model

Area of Science:

• Healthcare economics
• Transitional care interventions
• Stroke rehabilitation

Background:

• The COMprehensive Post-Acute Stroke Services (COMPASS) model is a transitional care intervention for stroke patients.
• It was evaluated against standard care in a cluster-randomized trial across 40 North Carolina hospitals.
• This study specifically analyzed the hospital-level costs of implementing and sustaining the COMPASS model.

Purpose of the Study:

• To examine the hospital-level costs associated with implementing and sustaining the COMprehensive Post-Acute Stroke Services (COMPASS) model.
• To identify factors influencing these costs, such as patient volume and enrollment numbers.
• To assess the potential cost-effectiveness of the COMPASS model in reducing overall healthcare expenditures for stroke survivors.

Main Methods:

• An activity-based costing survey was used to estimate hospital-level resource costs for COMPASS-related activities over approximately one year.
• Data were collected from 22 hospitals actively engaged in COMPASS.
• Hospital-level costs per COMPASS enrollee were estimated using median wage data and COMPASS enrollment figures.

Main Results:

• Between November 2017 and March 2019, 1582 patients received the COMPASS intervention across 22 hospitals.
• Average annual hospital-level COMPASS costs were $2861 per patient.
• Increased stroke patient volume (10% higher) correlated with a 5.1% decrease in COMPASS costs per patient (P=0.016).
• Postacute clinic visits and case ascertainment were the highest cost activities for many hospitals.

Conclusions:

• The costs of implementing the COMPASS model demonstrated variability across hospitals.
• Hospitals with higher stroke volumes and enrollment reported lower per-patient costs.
• The COMPASS model has the potential to reduce net costs if it can prevent approximately 6 stroke readmissions annually.