The Agency for Healthcare Research and Quality has issued the phase one final report of the Patient Outcomes Research Team (PORT) on stroke. The final report pulls together the literature review and all of the findings developed since the study was funded in 1991.
The report includes a CD-ROM that provides complete documentation specifications for the Stroke Policy Model, a simulation model for studying the costs and outcomes of the natural history of stroke, as well as the costs and outcomes associated with various preventive or therapeutic interventions. The documentation—which includes programming codes, algorithms, and all input data used in the model—is designed to help facilitate and encourage the use of this model in other related studies of stroke interventions by other researchers. This model can help determine the return on investment from quality improvement programs focused on stroke prevention and treatment.
The goal of the Stroke PORT, headed by David Matchar, M.D., of Duke University, was to improve health outcomes for people at high-risk for stroke by identifying appropriate and cost-effective strategies for secondary and tertiary stroke prevention. The study identified two stroke prevention interventions with significant potential to improve public health: carotid endarterectomy and anticoagulation with warfarin.
During their evaluation, the researchers found that, although effective in preventing strokes related to atrial fibrillation, warfarin is underprescribed, mostly because its effects can be difficult to monitor. In addition, a substantial proportion of eligible patients who are taking warfarin are not receiving effective doses, placing them at risk of stroke (doses too low) or bleeding (doses too high). To determine the best way to monitor the use of warfarin, in 1996 the PORT began a second phase, the Managing Anticoagulation Services Trial, or MAST, which is cosponsored by the DuPont Pharmaceuticals Company through a public-private partnership. The MAST is an intervention project organized around a randomized trial comparing coordinated anticoagulation services with usual practice. This second phase of the study is expected to be completed by the end of 2000.
The report and CD-ROM are available as a packaged set (AHRQ Publication No. 00-N001) from the AHRQ Publications Clearinghouse.
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