Has this team worked together as a group progressing organisational change or service redesign before? If yes, on what? What was the outcome? (probe for track record) Experience of the Project and the Change Outcome Are you aware which are the key meetings in the hospital which are involved in progressing this project? Is a group at the centre of the hospital charged with the project as a whole? If so, who? How have they interfaced with your clinical setting? How have you fed back or reported back to them? Have they influenced the way you have worked on the Value Based Healthcare project? What were the original objectives that you had to achieve within your clinical setting? How much progress do you think you have achieved so far? What might be the explanation for this change outcome, at least as apparent so far? Exploring receptivity to change amongst individuals, clinical and the centre Quality and Coherence of “Policy” Do you feel there are strong or compelling reasons for undertaking a project like this? Did you have to be convinced to participate? Was a strong vision of the project’s aims presented to you? What do you, personally, hope to gain from the project? Your division? How important is gathering better data on your work setting, through the project, to you?
Stroke Costs and Length of Stay There were 947 patients in the dataset (another 472 patients were returned to other hospitals and were excluded from further analysis). The first date of admission was in January 2013 (the date at which a new version of the stroke national audit was introduced) and the latest date of admission was September 2014 (financial data were analysed until March 2014). The sample comprised 424 women (45%) and 523 men (55%). Mean age was 67.7 years (standard deviation 15.5 years). Ethnicity was coded in 90% of episodes. Of those for whom ethnicity was coded, 472 (55%) were White British, 211 (25%) were of any Black background, 50 (6%) were of any Asian background and 123 (14%) were of mixed or other ethnicity. Mean costs for each stroke episode over the six months following admission were £9,518 (Standard Deviation £14,962). A histogram of costs (not shown) indicated that these were strongly right skewed. A graph of mean costs over time is shown below (Figure 1). A linear regression demonstrated that there was no significant trend in costs over time (Wald test p value for the coefficient differing significantly from zero was 0.56). This was also the case when costs were controlled for age, gender and ethnicity as well as comorbid cardiac failure, hypertension, atrial fibrillation, diabetes and previous stroke (Wald test p value 0.83). Figure 1 Mean Treatment Costs for Stroke, by Month of Admission Note. Costs are shown for the period bounded by the earliest date of the stroke quality data the latest date at which financial data were available. Mean LOS was 8.4 days (standard deviation 16.3 days). As LOS was skewed, we performed quantile regression, which demonstrated that there was no effect of month of admission on median LOS (p>0.99). Quality and Outcomes Overall, 63 (7%) patients died as inpatients and 65 (7%) died within 30 days of admission. was no trend in the odds of mortality, whether inpatient mortality or 30 day mortality was examined (p=0.49 and p=0.33 respectively).