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Creating better outcomes for Estonian stroke patients


In Estonia, recovering stroke patients were often receiving fragmented care – creating great potential for improving chances of recovery if care were more integrated. 

The Estonian Health Insurance Fund (EHIF) identified the need to develop a two-year patient pathway pilot for ischemic stroke to include patient-reported outcome measures, clinical outcome measures and costs, and to employ the ICHOM Set for stroke in 2020.


The pilot program included four of the six hospitals in Estonia that provide acute stroke care. 

During the pilot, NHG’s central role was to support the overall management of the project and provide an integrated IT solution together with its partners: Philips supplied the software that enabled the collection of patient-reported outcomes data, and financial data was provided by EHIF.  

NHG has linked this data with clinical outcomes to create a visual BI dashboard which, for example, can document the relationship between costs and outcomes for ischemic stroke care, and can also evaluate the deviation from the average between different hospitals to show where improvements need to be made.  


This benchmarking has enabled hospitals and clinicians to detect and learn from the best practices in stroke care. The dashboard built by NHG enables the comparison of outcomes and costs between separate hospitals, patient groups, and care paths, as well as offering a deep dive into specific dimensions of stroke care costs during each stage along the pathway to recovery. The dashboard is also highly valuable in evaluating what impact each intervention defined in the pilot program has on outcomes and costs, and enables improvements in patient processes to support patient needs.

For EHIF, this initiative allowed them to employ a bundled payment model for the entire stroke patient pathway in Estonia. A price has now been fixed for the stroke patients’ entire care pathway over 365 days. There are seven fixed prices dependent on the treatment group and age (these being the main cost drivers).  

Read more on the pilot in the ICHOM & NHG blog series: