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Case Study

How Christiana Care reduced unwarranted variation in stroke care

20 Minute Read


The challenge

In 2015, Christiana Care transitioned their clinical governance from a hospital department model to a system wide service line model to prepare for value based care. In 2016, they launched a care pathways initiative to optimize patient outcomes, enhance financial viability, and improve patient, provider, and staff experience. Stroke was one of the conditions with opportunity to reduce unwarranted care variation.

The organization

Christiana Care is a two hospital system based in Wilmington, Delaware, with a large integrated network of 1,500 providers, including 500 employed providers. The main hospital has over 900 beds and was ranked 22nd in the nation for inpatient volume in 2017.

The approach

By addressing six strategic questions about care standardization, Christina Care was able to update their stroke care guidelines to meet the standards set by the Joint Commission for comprehensive stroke centers, while also eliminating duplicative imaging, ensuring appropriate specialist follow up, and improving efficiency of patient rounding.

The result

Through their CVR efforts, Christiana care was able to increase adherence for best practice guidelines for stroke treatment and reduce the rate of duplicate imaging from 13% to 5%.



How Christiana Care improved COPD outcomes through CVR

CVR helped Christiana Care increase compliance with stroke care guidelines, improve quality performance, and reduce waste through the reduction of duplicative imaging.

Overview of Christiana Care’s CVR approach for stroke

The chart below is a summary of how Christiana Care answered six key questions for reducing unwarranted care variation.


The six questions

Leaders at Christiana Care reduced unwarranted variation in stroke care by addressing six strategic questions:

  • Question

    How much of the care pathway could Christiana Care address?

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  • Question

    Which components of care did Christiana Care standardize?

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  • Question

    What enablers helped translate the standards into practice?

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  • Question

    How did Christiana Care roll out new care standards?

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  • Question

    How does Christiana Care reinforce adherence?

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  • Question

    How does Christiana Care know what’s working?

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Christiana Care’s stroke outcomes after CVR initiative

Christiana Care used CVR to tackle both care quality and cost. Their focus on cost containment and cutting waste is reflected in their reduction of duplicate imaging. Additionally, they’ve shown strong quality performance driven by adherence to best practice guidelines for stroke treatment. Of more than 2,000 stroke patients treated annually, 98% meet the high bar for quality set by the Joint Commission for comprehensive stroke centers.


Reduction in duplicate imaging order rates (13% to 5%)


Of stroke patients received care consistent with all
Joint Commission core measures


Stroke PowerPlan adherence across the health system

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