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Updated: Jul 31, 2025
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Prioritizing Quality Measures in Acute Stroke Care : A Cost-Effectiveness Analysis
Jinyi Zhu1, Hooman Kamel2, Ajay Gupta3
1Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (J.Z.).
Annals of Internal Medicine
|May 1, 2023
Summary
Prioritizing acute ischemic stroke (AIS) quality measures shows significant value variation. Early carotid imaging and IV tPA offer the most benefit, guiding quality improvement efforts.
Area of Science:
- Health economics
- Stroke care quality improvement
- Medical decision making
Background:
- The American Heart Association and American Stroke Association (AHA/ASA) endorse 15 quality measures for acute ischemic stroke (AIS).
- Identifying high-value measures can reduce administrative burden while maintaining quality improvement.
- Prioritization is needed to optimize resource allocation in stroke care.
Purpose of the Study:
- To prioritize AHA/ASA-endorsed quality measures for AIS based on health impact and cost-effectiveness.
- To identify the most impactful quality improvement strategies for AIS patients.
- To inform providers and payers on value-based care decisions.
Main Methods:
- Utilized an individual-based stroke simulation model.
- Analyzed published literature for data on U.S. patients with incident AIS.
- Modeled current versus complete (100%) implementation of 10 AHA/ASA-endorsed quality measures over a lifetime horizon from a healthcare sector perspective.
Main Results:
- Complete implementation of AIS quality measures yielded substantial life-years gained, ranging from 472 (tobacco counseling) to 34,688 (early carotid imaging) per annual cohort.
- All measures were cost-saving or highly cost-effective (<$50,000 per QALY).
- Early carotid imaging and intravenous tissue plasminogen activator (IV tPA) accounted for 72% of the total potential value; the top 5 measures contributed 92%.
Conclusions:
- Significant variation exists in the net benefit of AIS quality improvement measures.
- Benefits are concentrated among a few key measures, particularly early carotid imaging and IV tPA.
- Results provide a framework for prioritizing quality improvement efforts and value-based payments in AIS care.
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