A Model for Hospital Collaboration—No Government Action Required

Philip Betbeze, April 2, 2010

St. Luke's Episcopal Hospital in Houston didn't need a massive healthcare overall to reform care. Its Stroke Partners Network is at the vanguard of the collaborative, cost-effective kind of care that helps more patients survive strokes and prevents suffering and hospitalizations. And by the way, it's a profitable business model, both for St. Luke's and the hospitals in the network.

About a year ago, St. Luke's, which has a comprehensive stroke program that's among the best in the country, began a discussion with consultants from GE Healthcare that led to the network. Essentially, it provides 24/7 stroke expertise from St. Luke's clinical team to hospitals in the hinterlands, who might receive a patient with a stroke for whom time is of the essence for effective treatment.

Of the 409 hospitals in Texas, almost 300 have been designated as having limited capabilities to treat patients with complex neurological disease, such as stroke. Yet, 80% of the state's stroke patients are seen at these hospitals. That means the majority of these patients aren't getting the best treatment available for a time-sensitive affliction.

A 63-year-old grandfather and resident of Vidor, TX, near the Louisiana border, suffered a stroke at home Jan. 23. More than three hours from Houston, his wife took him to their local community hospital, CHRISTUS St. Elizabeth's, which has limited stroke capabilities. But because St. Elizabeth's is involved with the St. Luke's system of care, through telecommunication with St. Luke's, local physicians were armed with expert guidance and the most aggressive treatments available to treat the man.

Through collaboration with the team at St. Luke's and Baylor physicians, local physicians dissolved the clot that was causing the stroke and bought him time to be transported safely to St. Luke's for surgery.

Less than a week after his stroke, he walked out of St. Luke's with minimal affects from the stroke and surgery.

The outcome most certainly would not have been this positive had the system not been in place. The system of care St. Luke's developed took a standalone program and essentially started a business that allows underserved communities to access this advanced stroke care. In return, St. Luke's gets referrals for the most serious events.

St. Luke's now has a target list of 54 hospitals they think would work well to funnel patients to it, once primary treatment is given at the local hospital. Three other hospitals besides St. Elizabeth's will go live with the telemedicine system in May and June, but as many as 54 could be targeted for inclusion.

Hospitals like St. Luke's often fear that when they create this type of relationship, the sending hospital will only forward patients who cannot pay or patients who will end up severely disabled, which from an outcomes perspective doesn't help St. Luke's. But St. Luke's designed systems and structures designed to keep participants from “gaming” the network.

For example, St. Luke's doesn't partner with any hospital that does not have all of its clinical staff trained and certified in the National Institutes of Health's stroke scale. That ensures that the folks making decisions 100 miles away are trained in stroke best practices. The partners have quarterly governance meetings, where they discuss metrics, performance, and outcomes.

As of mid-March, St. Luke's and its partners have had between 20 and 30 “activations” of the network since the beginning of January, which resulted in nine transfers to St. Luke's. Of those nine, five had advanced procedures.

That's likely five lives that won't be destroyed by stroke, and five people who can resume somewhat normal lives, instead of being confined to a terrible fate of wasting away in expensive long-term care.

This type of collaboration cuts cost and improves quality, and isn't that what healthcare reform is supposed to be all about?

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Philip Betbeze

Philip Betbeze is the senior leadership editor at HealthLeaders Media.

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