Estonian Stroke Patient Pathway



The aim of the Stroke Patient Pathway Pilot was to improve patients’ quality of life through developing more integrated care pathway from the patient’s view. The pilot consisted of three major parts – various development projects that four hospitals were leading, measuring patient reported outcomes, and testing a new, bundled payment model for the whole stroke care pathway. With this project the Estonian Health Insurance Fund took a big leap towards value-based healthcare.

After identifying the main challenges, the designing process began. In the workshops, it became clear, that the innovation itself should take place near the patient. This meant, that instead of a central national level change, the change needed to happen at hospital level. To support the change, care providers needed to be equipped with the necessary tools and resources. The development projects lead by hospitals sought solutions to the development needs that emerged most acutely in the current treatment journey: a patient-centered approach, a unified treatment plan, collaboration and role distribution, the creation of a coordinating role, the development of home and community services, and the measurement of patient outcomes.

The intervention group size was 264 patients and the control group consisted of 1771 patients. Summing up, we can say that the project was successful. On average, patients in the intervention group performed as good or better than those in the control group: the annual mortality rate was nearly twice as low (16% versus 30%); in the intervention group nearly three times more patients attended a neurologist’s or internal medicine doctor’s appointment after half a year (30% versus 9%); 43% of patients in intervention group attended in inpatient rehabilitation, but in control group only 29% of patients; 24% of patients of intervention group attended in outpatient rehabilitation vs 10% patients of control group.

The best interventions tested by hospitals (development projects), which are also recommended for wider practice, were the stroke nurse and stroke coordinator services. For both interventions, it was found that the availability of the service was highly appreciated by patients, close ones and other parties involved in the treatment journey. In addition to healthcare-based interventions, various community services were tested, with a particular focus on building a network support services.

One of the important results, is the need to standardise the stages of the treatment journey and agree on common criteria for the treatment of the patient.