Illustration of human head and brain

Stroke severity is the most important predictor of how patients will fare after their stroke, and may be the most important factor in relating hospital performance to 30-day stroke mortality rates.

A statement released on Thursday by the American Heart Association/American Stroke Association discusses the science behind developing risk adjustment models for stroke patients with ischemic strokes, caused by a blockage in a blood vessel in or near the brain.

Risk adjustment is the statistical process of determining appropriate costs to healthcare plans based on risk profiles of patients sharing similar characteristics. Medical insurance plans use risk adjustment to determine how much they will reimburse hospitals for the care they provide.

In addition to stroke severity, risk adjustment models should include age, gender, other illnesses and conditions, blood vessel risk factors and how well patients functioned before their stroke, according to the statement.

Hospitals caring for stroke patients should use a consistent standardized risk adjustment model that can ensure the reliability and the accuracy of assessing severity after stroke. Benefits, limitations and the potential unintended consequences to both patients and hospitals of risk adjustment or inadequate risk adjustment are also discussed.

The consequences include hospitals avoiding sicker patients for fear they won’t be reimbursed adequately or will be penalized. Patients with misclassified stroke severity could be denied additional rehabilitation services that could help their recovery. In addition, families and patients could be steered away from palliative care by hospitals looking to avoid penalties for prolonging the dying process.

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