Cost Effectiveness of Drive and Retrieve System in Hokkaido for Acute Ischemic Stroke Patient Treatment Using Geographic Information System

Effects of Systemic Rehabilitation Nursing Combined with WeChat Publicity and Education on the Early Cognitive Function and Living Quality of the Patients with Cerebral Arterial Thrombosis

Objective

To investigate the effects of systemic rehabilitation nursing combined with WeChat publicity and education on the early cognitive function and living quality of the patients with cerebral arterial thrombosis.

Methods

Ninety-two patients with cerebral arterial thrombosis treated in our hospital (January 2019–January 2021) were selected as the research objects and equably divided into control group and study group according to their nursing model, with 46 patients in each group. The control group received routine nursing, while the study group received systemic rehabilitation nursing combined with WeChat publicity and education based on the routine nursing. The early cognitive functions, living quality, and other observation indexes of the two groups after nursing were compared, and the intervention effects were evaluated.

Results

No statistical difference in the general data was observed between the two groups (P > 0.05). The NIHSS (National Institutes of Health Stroke Scale) scores, Fugl-Meyer scores, and MoCA (Montreal Cognitive Assessment) scores of the two groups after nursing were all better than those before nursing, and the NIHSS score, Fugl-Meyer score, and MoCA score of the study group after nursing were better than those of the control group (P < 0.05). Compared with the control group, the study group had a remarkably higher excellent and good rate of daily living ability after nursing (P < 0.05) and prominently higher SIS (Sensory Index Score) after nursing (P < 0.05). The SIS included the scores of emotion, strength, ADL (activities of daily living), memory and thinking, hand function, communication and participation as well as the total score.

Conclusion

The systemic rehabilitation nursing combined with WeChat publicity and education can effectively reduce the degree of neurological deficit of the patients with cerebral arterial thrombosis, improve their early cognitive function and motor function, and increase their daily living ability and prognostic living quality.

Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke

OBJECTIVES

There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients.

MATERIALS AND METHODS

he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times.

RESULTS

DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested.

CONCLUSIONS

Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.