Strategic planning to reduce the burden of stroke among veterans: Using simulation modeling to inform decision making

Kristen Hassmiller Lich, Yuan Tian, Christopher A. Beadles, Linda S. Williams, Dawn M. Bravata, Eric M. Cheng, Hayden B. Bosworth, Jack B. Homer, David B. Matchar

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - : Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. METHODS - : A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. RESULTS - : At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35 517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27 856) and hypertension control among diabetics (23 100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. CONCLUSIONS - : Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained.

Original languageEnglish (US)
Pages (from-to)2078-2084
Number of pages7
JournalStroke
Volume45
Issue number7
DOIs
StatePublished - Jul 2014

Fingerprint

Quality-Adjusted Life Years
Veterans
Decision Making
Stroke
Numbers Needed To Treat
Hypertension
Population
Cardiovascular Diseases
Rehabilitation
Veterans Health
Thrombolytic Therapy
Tissue Plasminogen Activator
Primary Prevention
Secondary Prevention
Uncertainty
Strategic Planning
Research

Keywords

  • comparative effectiveness research
  • computer simulation
  • health planning
  • stroke
  • Veterans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Strategic planning to reduce the burden of stroke among veterans : Using simulation modeling to inform decision making. / Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A.; Williams, Linda S.; Bravata, Dawn M.; Cheng, Eric M.; Bosworth, Hayden B.; Homer, Jack B.; Matchar, David B.

In: Stroke, Vol. 45, No. 7, 07.2014, p. 2078-2084.

Research output: Contribution to journalArticle

Lich, Kristen Hassmiller ; Tian, Yuan ; Beadles, Christopher A. ; Williams, Linda S. ; Bravata, Dawn M. ; Cheng, Eric M. ; Bosworth, Hayden B. ; Homer, Jack B. ; Matchar, David B. / Strategic planning to reduce the burden of stroke among veterans : Using simulation modeling to inform decision making. In: Stroke. 2014 ; Vol. 45, No. 7. pp. 2078-2084.
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AB - BACKGROUND AND PURPOSE - : Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. METHODS - : A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. RESULTS - : At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35 517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27 856) and hypertension control among diabetics (23 100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. CONCLUSIONS - : Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained.

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