Methods

We used a healthcare delivery redesign method to develop a composite of care delivery strategies with potential to improve value for ischemic cerebrovascular disease. 3 First, we conducted a medical literature review of epidemiology, intervention effectiveness and cost effectiveness, and clinical guidelines to identify opportunities for improvement. We subsequently conducted observations and interviews with patients and providers at 6 sites, adapting human-centered design methods from Stanford’s Biodesign Program. 3 Our interviewers sought to identify frustrations, or disgusters, encountered by patients and providers to determine opportunities to improve the experience of care. 4 Incorporating findings from these efforts, we listed unmet needs of patients, clinicians, and payers. Needs were ranked by expected impact of fulfillment on (1) health outcomes,(2) experience of care, and (3) total per-capita healthcare spending using a Likert scale–based system. To expand our thinking about higher-value stroke care, we observed or performed interviews at US and international sites nominated by health services and clinical experts for delivering high-quality care at relatively low cost. Finally, we studied processes used for other medical conditions and in other industries (the adjacent possible) 3 with potential to improve value in cerebrovascular disease care. We refined a composite of care delivery strategies with the participation of expert advisors, including clinicians, social scientists, health services researchers, and business leaders. We estimated potential savings from the health system perspective, deducting operating costs of new care delivery strategies (for methods and calculations, see Tables I–V in the online-only Data Supplement). These methods were exempted from review by the Stanford Institutional Review Board.