Harmonising data collection to deliver high value stroke care

The challenge

Stroke is one of the leading causes of disability worldwide[1] and is associated with high health and social care resources and costs.[2] According to a 2020 report on the burden of stroke in Europe,[3] stroke costs €60 billion, with healthcare accounting for €27 billion (45%) – representing 1.7% of health expenditure.

Readmission rates after stroke are over 25%, post-stroke home rehabilitation is under 5% and post-stroke depression affects 45-75% of patients.[4] Readmissions after stroke are related to discharge destination and conditions. So, greater support for transition to home after stroke is needed to reduce unplanned readmissions.

Non-value-based practices in post-acute and post-hospital stroke care lead to inefficiencies, silos of care and lack of continuum of care. The result is fragmented care with minimal coordination across providers and hospitals.[5]

Health transformation is needed to implement value-based stroke care programmes and ensure the equity of stroke care among patients in Europe. Value-based care is the equitable, sustainable, and transparent use of the available resources to achieve better outcomes and experiences for every patient.

Low standardisation of clinical processes and collected outcome measurements can increase variability in clinical results and care costs. There is a lack of systematic and centralised post-hospital data collection programmes at regional level.[6] This makes it hard to benchmark results and patient experience outcomes effectively. In turn, this hinders the sharing of best practices to support the implementation of high-value stroke care.

The solution

To achieve the transformation needed to implement value-based stroke care, there needs to be a standardisation and harmonisation of clinical processes, KPIs (key performance indicators) and outcome measurements. Effective data collection and health economic evaluation is needed to achieve effective implementation of value-based care throughout the stroke care pathway.[7]

HARMONICS aims to create a novel centralised EU stroke outcome registry that will integrate outcome data from each regional registry, designed and implemented within the project. The aim is to automatically capture KPI and outcome measures from electronic medical health records, providing regional and inter-regional benchmarking and sharing best practices. Through this solution, stroke patients will be monitored, mainly at the post-acute and post-hospital level, ensuring better outcomes, improving recovery, and preventing recurrence.

Expected impact

HARMONICS represents a comprehensive stroke care ecosystem. It aims to implement an innovative high-value care solution, focused on post-hospital care in stroke centres and corresponding primary care areas in two European regions, Catalonia and Coimbra.

HARMONICS will benchmark best practices and clinical results to ensure optimal stroke outcomes and propose innovative value-based payment models. In this way, the project promises to enhance the efficiency of healthcare systems at regional level. Ultimately, it aims to improve patient value perception and boost quality of life for stroke patients across Europe.

External Partners
  • Administração Central do Sistema de Saúde (ACSS)
  • Biokeralty Research Institute AIE
  • Fundació Ictus (FI)
  • Osakidetza-Servicio Vasco De Salud
  • Servei Catala de la Salut (CatSalut)
  • Biocruces Bizkaia Health Research Institute

[1] Wafa, H. A., et al. (2020). Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years. Stroke, 51 (8), 2418–242.

[2] Katan, M. and Luft, A. (2018). Global Burden of Stroke. Seminars in Neurology, 38 (2), 208–211.

[3] Luengo-Fernandez, R.  et al. (2020). At what cost the economic impact of stroke in Europe. The Burden of Stroke in Europe Report.

[4] Santana Baskar, P. et al. (2021). In-hospital acute stroke workflow in acute stroke – Systems-based approaches. Acta Neurologica Scandinavica, 143(2), 111–120.

[5] Lacy, C. R., Suh, D. C., Bueno, M., and Kostis, J. B. (2001). Delay in presentation and evaluation for acute stroke: Stroke time registry for outcomes knowledge and epidemiology (S.T.R.O.K.E.). Stroke, 32( 1), 63–69.

[6] Reeves, M. et al. (2018). Patient-Reported Outcome Measures (PROMs) for acute stroke: Rationale, methods and future directions. Stroke, 49(6), 1549–1556.

[7] Porter, M. E. and Lee, T. H. (2013). The Strategy That Will Fix Health Care. Harvard Business Review [online] Available at: https://hbr.org/2013/10/the-strategy-that-will-fix-health-care [Accessed 24th March 2022]

Carlos Molina
| Clinical Lead, Head of Stroke Unit | Hospital Universitari Vall d’Hebron
Victoria Valls
| Activity Lead, Quality, Processes and Innovation Directorate | Hospital Universitari Vall d’Hebron
Laura Rabanal
| Project Manager, Stroke Unit | Hospital Universitari Vall d’Hebron