Using markov systems to plan stroke services

Abstract

We have previously used Markov models to describe movements of patients between hospital states. The distribution of costs at any time and in a given time interval were also previously evaluated and expressions found for the corresponding means and variances. In this paper we extend our previous model to a system that includes on-off costs of making a transition from one state to another; previously costs were per day for the appropriate state. Such transition costs allow us to evaluate the overall costs of therapy or a clinical intervention where an operation or other intervention may be an option. This model can be used to determine costs for the entire system for different strategies thus facilitating a systems approach to the planning of healthcare and a holistic approach to costing. Such models can also help us to assess the complex relationship between hospital and community care where there may be possible trade-offs between hospital treatment costs and community care costs. Such a scenario is commonly encountered in stroke disease where care may include a long period of rehabilitation or residence in a nursing home. © 2009 Springer-Verlag Berlin Heidelberg.