Collaborative Care on the Stroke Unit: A Cross-Sectional Outcomes Study

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Abstract

Objective: The aim of this study was to evaluate the economic and quality outcomes associated with a collaborative advanced practice nurse and hospitalist physician model of care on the inpatient stroke unit as compared with usual hospitalist physician-led care. Background: High functioning collaborative teams are anticipated to be essential under value-based reimbursement. Methods: Hospitalist nurse practitioners were assigned to the stroke unit in collaboration with hospitalist physicians to implement daily hospital management for patients with stroke and transient ischemic attack. To evaluate outcomes associated with the care model, a retrospective cross-sectional design was used with 100 patients in the collaborative advanced practice nurse and hospitalist physician care group and 100 patients in the usual hospitalist physician-led care group. Primary outcome measures were length of stay, 30-day readmissions, stroke core measure documentation, and patient experiences of care. Analysis of demographic characteristics assured that the samples were similar. Results: The collaborative care group performed better on one of five stroke core quality measures and on two of three patient experiences of care measures. Mean length of stay and hospital readmissions were similar between groups. Five patients left the stroke unit against medical advice in the usual hospitalist physician-led care group, whereas there were no discharges against medical advice in the collaborative care group. Conclusion: Advanced practice nurse and hospitalist physician collaboration is a promising model for healthcare quality improvement during inpatient stroke care; results are likely generalizable to other adult medicine populations.

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