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Objective To examine the impact of inter-provider care coordination on health-care resource utilization among elderly acute stroke patients. Design A retrospective cohort study using health-care insurance claims data. Setting Claims data of the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare. Participants About, 6409 patients aged 75 years or older admitted for acute stroke and moved to rehabilitation wards from 1 April 2010 to 30 September 2015. Main outcome measure Lengths of stay (LOS) and total charge (TC) were evaluated according to three groups of care pathways (coordinated care, integrated care and other pathways). Results Compared with the other care pathway, the coordinated care groups had significantly shorter LOS of 2.0 days in acute ischemic stroke care; they had 2.5 days shorter LOS in hemorrhagic stroke care. However, there were no significant differences in rehabilitation care LOS and TC. Conclusions Our findings suggest that a payment system for care coordination is inappropriate since it was not associated with a reduction in overall health-care resource utilization. Further, health-care system reform is necessary to improve care continuity across multiple health-care institutions in Japan.