Value-based health care in stroke
24 Apr 2017

This is a summary of the pilot study regarding the development of a value-based monitoring platform for stroke care in Sweden.

Initial analysis of data

To understand the relevant outcomes, historical data from 2010 on more than 14,000 stroke patients was analyzed. The analyses included both acute care as well as subsequent care, and included data from both the county councils’ patient registries and national quality registries. The results were adjusted for patient case mix at the respective care provider and county council to enable comparability.

Value based health care model

Based on the analysis of the historical cohort and the expert working group the following parameters were included in the VBHC model:

Health outcomes

  • 1 year survival
  • Free from relapse, 1 year
  • Changed sick leave, year 1
  • Good activity capacity after 1 year
  • Good overall health after 1 year

Resource use

  • Inpatient days, year 1
  • Outpatient visits, year 1
  • Net-days of sick leave, year 1
  • New home care hours, year 1
  • Proportion in nursing homes, year 1

The analyses showed significant differences in health outcomes and resource use within Swedish stroke care. The correlation between patient characteristics and health outcomes was stronger than the relationship between patient characteristics and consumed care, and the levels of resource consumption appeared to be more related to how health care is organized in the county councils. At the care provider level, there is no clear correlation between increased resource use and improved health outcomes, neither after case mix adjustment.

Recommended actions

Based on the analysis, Sveus’ expert group in stroke care recommended the establishment of a value-based monitoring platform to enable new and important follow-up of stroke care. In the platform, resource and performance measures can be compared between care providers and county councils.

For more information (in Swedish only):  

Sveus is an ongoing research and development project aimed at developing models for value-based health care (VBHC) in several disease areas in Sweden. Seven county councils and regions participate in the work, with support from the Ministry of Social Affairs, including involvement of more than 50 organizations.