Supplemental Evidence Tables

ECRI Health Technology Assessment Group

This publication is provided for historical reference only and the information may be out of date.

Supplemental Evidence Tables

Evidence Table S-1. Historical Controls for No-program Pneumonia Incidence in Consecutive Stroke Patients in Acute-care Settings

Evidence Table S-2. Proportion of Acute Stroke Patients Evaluated by Full BSE or VFSS in Ongoing Dysphagia Program

Evidence Table S-3. Proportion of Acute Stroke Patients Treated for Dysphagia Following VFSS in Ongoing Dysphagia Program

Evidence Table S-4. Dysphagia Programs for Prevention of Pneumonia in Consecutive Acute Stroke Patients Compared with Historical Controls

Evidence Table S-5. VFSS Costs

Evidence Table S-6. Swallow Therapy Cost

Evidence Table S-7. Aspiration Pneumonia Costs in Stroke Patients

Publication Details

Copyright

Publisher

Agency for Health Care Policy and Research (US), Rockville (MD)

NLM Citation

ECRI Health Technology Assessment Group. Diagnosis and Treatment of Swallowing Disorders (Dysphagia) in Acute-Care Stroke Patients. Rockville (MD): Agency for Health Care Policy and Research (US); 1999 Jul. (Evidence Reports/Technology Assessments, No. 8.) Supplemental Evidence Tables.

Evidence Table S-1. Historical Controls for No-program Pneumonia Incidence in Consecutive Stroke Patients in Acute-care Settings

Author	N	Study design	Time period and setting	Selection	Test(s)	Treatment	Mean age	Characteristics	Followup	Cumulative pneumonia (95% CI)	Adjustment factor	Adjusted to 2 week interval (95% CI)
Odderson, Keaton, and McKenna, 1995	90	HPCS	1993 Urban community hospital	Consecutive acute nonhemorrhagic stroke	?	?	75	All stroke	Mn LOS 9.3 days	6.7% (6/90) (3.1 to 14%)	1.105	7.4% (3.6 to 15%)
Young and Durant-Jones, 1990	216	CS	1987-89 Acute-care teaching hospital	Charts of randomly selected stroke patients over a 3-year period (4%, 9/225, excluded as comatose)	?	?	65	All stroke	4.4 wks	13% (28/216) (9.1 to 18%)	0.848	11% (7.5 to 16%)
Barker and Mullooly, 1997	196 247 275	RCS	Hospital 1967-71 1974-78 1981-84	All new stroke patients (WHO standard) over age 65 in an HMO			>65	All stroke	30 days	10% (20/196) 7% (17/247) 9% (25/275) Mean 8.6%	0.848	8.5% (5.4 to 13%) 5.9% (3.6 to 9.6%) 7.6% (5.0 to 11%) Mean 7.3% (5.6 to 9.4%)
Haerer and Smith, 1974	475	RCS	Hospital 1967-72	Consecutive strokes					LOS Mn 17.5 days	8.8% (42/475)	0.951	8.4% (6.2 to 11%)
Range Unweighted Mean Used in cost-effectiveness analysis: N-Weighted Adjusted Mean										6.7 to 13% 9.1% 9.2% (138/1,499) (7.8 to 11%)		5.9 to 11% 8.1% 8.2% (6.9 to 9.7%)

Evidence Table S-2. Proportion of Acute Stroke Patients Evaluated by Full BSE or VFSS in Ongoing Dysphagia Program

Author	N	Study design	Time period and care setting	Selection for program	Mean age	Patient characteristics	Selection for test	Proportion given SLP evaluation
Daniels, Brailey, Priestly et al., 1998	55	Case series	VA medical center	Consecutive patients admitted with new strokes; 2 patients excluded due to obtunded or agitated status or previous history of dysphagia	66	All new stroke patients	Intention was to give test to all stroke patients; 4% (2/55) patients excluded due to obtunded or agitated status or previous history of dysphagia	96% (53/55)
Akpunonu, Mutgi, Roberts et al., 1997	302	Case series	Dept. of Internal Medicine, Medical College	Consecutive stroke patients (except transient < 24 hr ischemic attacks) (between 1989 and 1993)	67			23% (69/302)
Teasell, McRae, Marchuk et al., 1996	441	Case series	University hospital rehabilitation unit, Ontario, Canada	Consecutive patients admitted to hospital rehabilitation unit less than 4 mos post stroke		All stroke within 4 mos., MBS Mn >5 weeks post-stroke	Those with clinical suspicion of aspiration	24% (106/441)
Odderson, Keaton, and McKenna, 1995	124	Historical prospective case series	1993, Urban community hospital	Consecutive acute nonhemorrhagic stroke	75	All stroke; BSE within 24 hours	Preliminary BSE	39% (49/124)
Odderson et al., 1995 (Odderson, Keaton, and McKenna, 1995)							Used in cost-effectiveness analysis	39% (49/124)

Evidence Table S-3. Proportion of Acute Stroke Patients Treated for Dysphagia Following VFSS in Ongoing Dysphagia Program

Author	N	Study design	Time period and care setting	Selection for program	Mean age	Characteristics	Selection for treatment	Proportion dysphagic at SLP evaluation
Daniels, Brailey, Priestly et al., 1998	55	Case series	VA medical center	Consecutive patients admitted with new strokes; 2 patients excluded due to obtunded or agitated status or previous history of dysphagia	66	All new stroke patients	Abnormal swallow at VFSS	65% (36/55)
Akpunonu, Mutgi, Roberts et al., 1997	302	Case series	Dept. of Internal Medicine, Medical College	Consecutive stroke patients (except transient < 24 hr ischemic attacks) (between 1989 and 1993)	67	All stroke patients (except transient <24 hr ischemic attacks)	Abnormal swallow at VFSS	16% (49/302)
Teasell, McRae, Marchuk et al., 1996	441	Case series	University hospital rehabilitation unit, Ontario, Canada	Consecutive patients admitted to hospital rehabilitation unit less than 4 mos post stroke		All stroke within 4 mos, MBS Mn >5 weeks post-stroke	Suspected of dysphagia and given VFSS Aspirated thin liquids at VFSS	24% (106/441) 19% (84/441)
Odderson, Keaton, and McKenna, 1995	124	Historical prospective case series	1993 Urban community hospital	Consecutive acute nonhemorrhagic stroke	75	All stroke; BSE within 24 hours	Preliminary BSE	39% (49/124)
Odderson et al., 1995 (Odderson, Keaton, and McKenna, 1995)							Used in cost-effectiveness analysis	39% (49/124)

Evidence Table S-4. Dysphagia Programs for Prevention of Pneumonia in Consecutive Acute Stroke Patients Compared with Historical Controls

Author	N	Care setting	Program	Follow-up interval	Cumulative pneumonia (95% CI)	Difference ¹ from no-program mean of 9.2% (95% CI)	Relative risk reduction ²	Adjustment factor	Cumulative adjusted to 2-week interval	Difference ¹ from adjusted no-program Mean of 8.2% (95% CI)	Adjusted RRR ²
Nilsson, Ekberg, Olsson et al., 1998	72	University hospital stroke unit, Sweden	Self-reported difficulty swallowing; diet consistency treatment only; IV drip but no tubes	26 wks	2.8% (2/72) (0.8 to 9.6%)	6.4% (-0.5 to 9.0%)	74%	0.800	2.2% (0.5 to 8.7)	6.0% (-0.6 to 8.3%)	73%
Odderson, Keaton, and McKenna, 1995 2^nd year	124	1993, Urban community hospital	Patients failing preliminary water test (39%) given formal BSE; diet, SLP therapy, tubes as needed	1.0 wk	0 (0/124) (0 to 3.0%)	9.2% (5.9 to 11%)	100%	1.183	0% (0 to 3.0%)	8.2 (4.9 to 9.7%)	100%
Daniels, Brailey, Priestly et al., 1998	55	VA medical center	All got MBS (65% were dysphagic, 38% aspirated); dysphagics got diet, SLP therapy, tubes as needed	13 wks	1.8% (1/55) (0.3 to 9.6%)	7.4% (-0.5 to 9.6%)	80%	1.018	1.8% (0.3 to 9.6%)	6.4% (-1.5 to 8.5%)	78%
Range Used in cost-effectiveness analysis: Adjusted RRR Unweighted Mean N-weighted Mean					0 to 2.8% 1.5% 1.2% (3/251) (0.4 to 3.5%)	6.4 to 9.2% 7.7% 8.0% (5.4 to 9.8%)	74 to 100% 85% 88%		0 to 2.2% 1.3% 1.3% (0.5 to 3.6%)	6.0 to 8.2% 6.9% 6.9% (4.3 to 8.6%)	73 to 100% 84% 87%

Evidence Table S-5. VFSS Costs

Author	Date	Setting	Components	Cost (charge or reimbursement)	Comments
Health Care Finanace Administration, 1997; American Speech-Language-Hearing Association (ASHA) and Health Care Financing Administration) (HCFA), 1998	1998	Inpatient	74230 Cinema Xray throat/esoph., $77 92525 Oral function evaluation reimburse., $73 1.5 SLP billable hours reimburse., $68	($218)
CKMD101@aol.com, 1997	1998	Medical center	Speech dept. charge, $300 Radiology charge, $268	($568)
Kimark390@aol.com, 1997	1998	Major hospital	1 hr. speech charge, $156 Radiology charge, $150	($306)
Aviv, 1997	1997	Univ. hospital, New York City	Medicare reimbursement including transportation from outside	($700)
Used in cost-effectiveness analysis				($218)	1998 Medicare reimbursement

Evidence Table S-6. Swallow Therapy Cost

Author

Date

Setting

Patient characteristics

Components

Cost (charge or reimbursement)

Comments

Health Care Finance Administration, 1997; American Speech-Language-Hearing Association (ASHA) and Health Care Financing Administration (HCFA), 1998

1998

Inpatient

1 hour session:
92526 Oral function therapy reimburse.,
$29
1 SLP billable hour reimburse.,
$45

1 month, 3X per week reimburse.,
$968

1 month, 5X per week reimburse.,
$1,291

1 month, 5X per week reimburse.,
$1,614

($74)

($968)

($1,291)

($1,614)

Odderson, Keaton, and McKenna, 1995

1998

Acute-care hospital

Stroke

6 daily sessions of 15 min. each:
92526 Oral function therapy reimburse., $29
15 min. SLP billable hour reimburse., $11.31

$40.27

$242

($242)

Gardner, 1998[unpub]

1998

13.2 treatments (mean, not including evaluation) cost, $1,280

$1,280

Used in cost-effectiveness analysis

$242

6 X 15 mins. per day, 1998 Medicare reimbursement

Evidence Table S-7. Aspiration Pneumonia Costs in Stroke Patients

Author	Date	Setting	Patient characteristics	Components	Cost (charge or reimbursement)]	Comments
Medicare, 1997 [table]	1998	Inpatient		The difference between DRG 17 (nonspecific cerebrovascular disorder, $2,454) and DRG 16 (nonspecific cerebrovascular disorder with comorbid condition, $4,618), $2,164	($2,164)
Reynolds, Gilbert, Good et al., 1998	1991-95	North Carolina Baptist Hospital	Stroke patients with aspiration pneumonia	Average extra cost for stroke/pneumonia patient versus stroke patient (29 day LOS vs. 10), $18,011	$18,011
Aviv, 1997		University hospital, New York City		Average medicare reimbursement for off-site transportation, 10-14 days LOS, antibiotics, ICU, intubation, ventilator, extubation; based on Boyce et al., 1991 (Boyce, Potter-Bynoe, Dziobek et al., 1991). McGarvey and Harper, 1993 (McGarvey and Harper, 1993), Paladino and Fell, 1994 (Paladino and Fell, 1994), ($19,000)	($19,000)
Paladino and Fell, 1994	1992	Fillmore Suburban Hospital, Williamsville, NY	Nosocomial pneumonia	Direct medical costs (including bed or hotel costs) for intermediate ICU for average case of nosocomial pneumonia, $10,660	$10,660
McGarvey and Harper, 1993	1990	Forbes Health System, a not-for-profit health care organization in southwestern Pennsylvania	Pneumonia clinical pathway	Average charge ($10,574)	($10,574)
McGarvey and Harper, 1993	1990		Pneumonia clinical pathway	As above but after implementation of quality improvement program ($9,629)	($9,629)
Boyce, Potter-Bynoe, Dziobek et al., 1991	1986	Miriam Hospital, Providence, RI	Medicare nosocomial pneumonia patients (mean age 77)	Hospital costs, $26,807
Boyce, Potter-Bynoe, Dziobek et al., 1991	1986	Miriam Hospital, Providence, RI	Medicare nosocomial pneumonia patients (mean age 77)	As above but Medicare reimbursement ($13,066)	($13,066)
Ahmad, Fergus, Stothard et al., 1988	1985	Hospital ICU	Respiratory system cases	Average hospital costs, $14,326	$14,326
Ibid	1985	Hospital ICU	Respiratory system cases	As above but Medicare reimbursement ($7,961)	($7,961)
Used in cost-effectiveness analysis					($2,164)	1998 Medicare reimbursement