HEALTH SERVICES ADMINISTRATION (HSA) 375 – Case Study 3

The Queen’s Health Policy Research Unit (QHPRU) estimated the need for stroke services in Brooklyn, New York using measures of prevalence and incidence of

(1) MODIFIABLE AND NONMODIFIABLE RISK FACTORS FOR STROKE

(2) ACUTE CASES OF STROKE

(3) MAJOR SEQUELAE OF STROKE

They identified the effective health services that are targeted at each of these three dimensions and linked these steps to estimate need for health services. They compared the estimate of need for health services to compiled measures of levels of stroke-related health services in Queens, New York to see if there was a gap (unmet need) or surplus (over met need) of these services.

1.      Risk factors for stroke include heavy alcohol consumption, atrial fibrillation, diabetes, hypercholesterolemia, hypertension, obesity, low physical activity, smoking, ischemic heart disease, and transient ischemic attack. Where might QHPRU get estimates of the incidence of these conditions?

2.      For each risk factor, or stroke sequelae, QHPRU listed the kind of intervention that would be effective, and the proportion of people for whom this intervention would be appropriate. According to Table 4.3, which three interventions are appropriate for hypercholesterolemia, and for what proportion of high-risk individuals?

(b)THROMBOLYTIC THERAPY

(c)  IMAGING OF THE BRAIN (CT OR MRI)

(d)NON-INVASIVE IMAGING OF THE VESSELS (ULTRASONOGRAPHY OR MAGNETIC RESONANCE ANGIOGRAPHY)

(e)  INVASIVE IMAGING OF THE VESSELS (CEREBRAL ANGIOGRAPHY)

(f)REHABILITATION THERAPY

For what percent of at-risk individuals are these services recommended?

4.      Estimates of people in Queens, New York with hypercholesterolemia are as follows:

 AGES 25-44: 30,000 MEN AND 13,000 WOMEN  AGES 45-64: 33,000 MEN AND 42,500 WOMEN

  AGES 65 AND ABOVE: 17,000 MEN AND 42,000 WOMEN

How many residents in Queens will need fasting lipoprotein analysis and dietary and pharmacologic interventions for hypercholesterolemia?

5.      It is estimated that Queens provides dietary and pharmacologic intervention for hypercholesterolemia to 66,000 and 15,500 patients respectively. What is the level of unmet need in terms of the number of patients not receiving each of these two recommended interventions?

What percent of need is not currently being met in Queens?

6.      The incidence of acute stroke cases was estimated at 3,500 cases, 100 of whom died before reaching the hospital. The prevalence of chronic stroke cases was estimated to be 4,300. Use Table 4.4 to estimate the number acute and chronic stroke cases needing core stroke services, and services for chronic stroke and disability.

It is estimated that Queens provides thrombolytic therapy and carotid endarterectomy to 50 and 200 patients respectively. CT and MRI brain imaging is provided to 1,000 and 150 patients respectively. Non-invasive and invasive imaging of the vessels is provided to 425 and 170 patients respectively. Rehabilitation is provided to 1,400 acute stroke survivors, and homecare services are provided to 1,400 chronic stroke with disability patients. What is the level of unmet need in terms of the number of patients not receiving each of recommended services for acute or chronic stroke victims? What percent of need is not currently being met in Queens?