Sunday, November 30, 2014

The 'hub and spoke model' of health care: how can we apply to stroke care in India

India is ranked 119 out of 169 countries in Human Development Index (HDI). It spends about 4% of the Gross Domestic Product (GDP) on healthcare, which ranks among the countries with least spending on healthcare. As such, it is essential for the health care organizations in India to manage the expenditure on healthcare in a prudent manner. In continuation to my earlier article on 'telestroke', I will discuss the 'hub-and-spoke' model of stroke care and how it can help us to maximize the benefits of high tech care while minimizing unnecessary costs.

The 'hub-and-spoke' model

Organized inpatient stroke care at designated stroke centers has been shown to reduce mortality and morbidity when compared to treatment at non-specialist centers. With increasing complexity of stroke care, it has become impossible to provide specialist stroke services in every hospital in a specific area. Stroke care involves management by a dedicated stroke team consisting of vascular neurologist, neurosurgeon, neurointerventionist, intensivist, radiologist, anesthesiologist, specialist nurses, rehabilitation facilities and other trained medical personnel. It also requires the availability of cutting-edge technology at their disposal. Given that this requires millions of rupees, it is virtually impossible to have all these facilities in every hospital in a designated area. A simple but effective solution to this problem is to organize the stroke care in the form of a network of hospitals that depend on each other for caring for patients with stroke. In the hub and stroke model, a single hospital with all the specialist physicians and high-tech infrastructure forms the 'hub' and all the other hospitals with lesser complexity of care form the 'spokes'. The 'hub' hospital will be able to maximize the use of its infrastructure and specialized care facilities as patients from all the 'spoke' hospitals that require specialized care are concentrated here. Whereas, the 'spoke' hospitals will be able to maximize the facilities as they have the backup of the 'hub' hospital. In a study from Phoenix, Arizona, a patient with acute ischemic stroke treated at a 'network' hospital incurred $1,436 lower costs than another patient treated at a hospital outside the network.

In addition to the patients receiving the best possible care, the hospitals stand to gain financially as a patient treated at the 'hub' hospital goes back to the 'spoke' hospital for follow up and rehabilitation. That the hospitals are connected makes it easier for researchers to conduct studies for enhancing stroke care. It also makes the implementation of awareness campaigns easier at a larger scale.The 'hub and spoke' model also makes it easy to treat othe disease conditions coronary artery disease, etc.

In another study from the Mayo Clinic involving a network with 1,112 unique acute ischemic stroke patients per year, the study estimated that 45 patients per year would receive intravenous thrombolysis who would not have received it in the absence of a network, and 20 more patients per year would receive endovascular stroke therapies, resulting in 6.11 more discharges to home in a network than in the absence of a network. Researchers estimated cost savings in the network overall at $358,435 per year for the first year, increasing to $393,712 at the end of the fifth year. The hub facility bore the brunt of the costs, which researchers estimated at $405,121 per year, while each spoke saved $109,080 per year. The researchers suggested that with appropriate cost-sharing arrangements, over a five-year period all hospitals in the system could save an average of $44,804 per year. The researchers claimed that their model showed a target transfer rate of approximately 30 percent resulted in cost savings to the hub, the spokes, and the network overall.

Hence, it is high time that the above model of stroke care is planned and implemented in the various states in India. It is through this model that sustainable and cost-effective  stroke care can be offered to the people.


No comments:

Post a Comment