How patient care changes when stroke centers offer endovascular thrombectomy
Adding endovascular thrombectomy (EVT) capabilities to existing stroke centers can lead to a massive shift in patient treatment patterns, according to new research published in Stroke. Such a shift, however, does not necessarily affect patient outcomes.
The study’s authors ran a simulation involving a health system made up of one comprehensive stroke center (CSC) and two EVT-incapable primary stroke centers. If one of those primary stroke centers gained EVT capability, making it a thrombectomy-capable stroke center (TSC), they wondered, what would be the overall impact?
“The value of TSCs—or more generally, hospitals with new EVT capability—is not completely understood,” wrote lead author Minerva H. Zhou, MD, an internist of Washington University in St. Louis, and colleagues. “In communities without access to EVT, the introduction of a TSC may fulfill an unmet regional need by increasing the number of patients who have timely access to treatment. In communities that already have access to EVT, the impact of adding a TSC may be less clear. Expansion of EVT capability in these settings may be costly for hospitals with constrained resources, dilute procedural volume and attendant expertise across multiple hospitals, and potentially compromise the overall quality of care.”
The team’s analysis involved a total of 80 million simulated patient encounters. The group simulated a bypass model, which sends patients with severe strokes to the nearest EVT-capable center, and a nearest center model, which sends all patients to the nearest location.
Overall, the bypass model found that adding a TSC “dramatically shifts” patient volume to that TSC. In fact, volume at the TSC increased by more than 40%—and volume at the existing CSC decreased by the same amount.
The nearest center model, on the other hand, saw no changes in patient volumes.
Looking specifically at patient outcomes, however, the authors found that “good clinical outcomes” only saw an absolute increase of 0.2% to 0.6% in the full patient population and an absolute increase of 0.3% to 1.8% in the TSC population.
One key takeaway from the group’s analysis is that health systems should not feel rushed to add EVT capabilities to all existing stroke centers, especially if the centers are located in more urban locations.
“Continually adding EVT-capable centers where such capability already exists may result in a relatively inefficient allocation of resources that does not substantially improve population health and exacerbates disparities in the care available to urban and rural communities,” the authors wrote. “Furthermore, the resulting dilution of volume from existing, experienced centers may inadvertently worsen patient outcomes and erode the already modest benefit of adding EVT capability in saturated, urban areas.”
Zhou et al. closed by highlighting the importance of closely thinking through decisions related to adding EVT capabilities to an existing stroke center.
“Hospital systems considering upgrading to a TSC should examine the relative balance of patient-centered and hospital-centered benefits before investing resources to add EVT capability,” they wrote.
Click here for the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.