Stroke: Fragmentation of Care Leads To More CT Scans, Higher Costs

Kimon Bekelis, MD Department of Neurosurgery Dartmouth-Hitchcock Medical CenterDr. Interview with:
Kimon Bekelis, MD
Department of Neurosurgery
Dartmouth-Hitchcock Medical CenterDr. Bekelis What are the main findings of the study?

Dr. Bekelis: We demonstrated  extensive regional and racial variation in the utilization of head CT scans in the first year after ischemic stroke. Increased use paralleled spending in corresponding Hospital Referral Regions. Greater fragmentation of care was associated with high intensity head CT utilization. African-Americans were associated with increased fragmentation of care and utilization of head CT. Were any of the findings unexpected?

Dr. Bekelis:  The extensive regional variation in the use of head CT for ischemic stroke has not been demonstrated before. In addition, the racial disparities in these practices are striking and are also reported for the first time. We identified that a major component of these utilization patterns is fragmentation of care, an issue not addressed previously through health care reforms. Hopefully the implementation of Accountable Care Organizations will minimize disparities and maximize continuity of care, with potential impacts in cost and overultilization. What should clinicians and patients take away from your report?

Dr. Bekelis:  We demonstrated that fragmentation of care is associated with overutilization of costly and potentially hazardous imaging modalities. From a physician’s perspective, every effort should be made to maintain continuity of care and enhance communication between providers in order to minimize this dangerous practice. Patients should avoid seeing multiple providers and be critical of unnecessary use of CT scans. Initiatives such as the “Choosing Wisely Campaign” can assist patients with decision-making. What recommendations do you have for future research as a result of this study?

Dr. Bekelis:  The best performing Hospital Referral Regions in terms of utilization and cost should be studied further. The particular practice patterns in these areas, and their methods of ensuring continuity of care should be identified. They can be used as examples that can be mirrored in order to maximize efficiency and minimize cost in the constantly changing health care landscape.


Fragmentation of Care and the Use of Head Computed Tomography in Patients With Ischemic Stroke.

Bekelis K1, Roberts DW, Zhou W, Skinner JS.
Circ Cardiovasc Qual Outcomes. 2014 Apr 8. [Epub ahead of print]