Association of Mobile Stroke Unit Care and Spending, Utilization, and Death in NYC

Early treatment for acute stroke has been shown to improve patient outcomes. In 2016, NewYorkPresbyterian Hospital, in collaboration with Weill Cornell Medicine, Columbia University Irving Medical Center, and the Fire Department of the City of New York started a mobile stroke unit (MSU) in NYC to deliver stroke workup and treatments while en route to the hospital. MSUs are specialized ambulances equipped with clinical staff, computer tomography (CT) scanners, and intravenous blood pressure and thrombolytic medications. 

While prior studies suggest that MSUs can improve several short-term outcomes for patients with acute stroke, there has been limited research on their long-term health and financial effects. A study in the Journal of the American Heart Association from Dr. Dhruv Khullar, associate professor of population health sciences, Dr. Amelia Bond, associate professor of population health sciences, Dr. Rainu Kaushal, senior associate dean for clinical research and chair of population health sciences, and colleagues, evaluates whether MSU care is associated with better health, utilization, and spending outcomes at one year for patients with suspected acute stroke.  

Researchers used data from the NYC MSU registry, 2016 to 2020 Medicare fee-for-service claims, the 2019 five-year American Community Survey, and electronic medical records from two NewYork-Presbyterian Manhattan hospitals. Patients transported by MSUs were compared to matched patients transported to the same hospitals by traditional ambulances. 

Compared to patients who were transported by traditional ambulances, patients who were transported by MSUs had a trend toward lower mortality at one year: 21.6 percent vs 28.4 percent. This finding did not reach statistical significance, possibly because of sample size. There were no significant differences in spending or follow-up hospitalizations and emergency department visits, indicating that MSU care was not associated with higher health care costs or utilization. The study suggests that MSU care has the potential to improve long-term mortality outcomes for patients with acute stroke in dense, urban environments, but larger, prospective trials are needed to confirm these findings. 

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