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Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan: A Nationwide Propensity Score-matched Study.

Authors :
Peng LN
Lu WH
Liang CK
Chou MY
Chung CP
Tsai SL
Chen ZJ
Hsiao FY
Chen LK
Source :
Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2017 Nov 01; Vol. 18 (11), pp. 990.e7-990.e12. Date of Electronic Publication: 2017 Aug 10.
Publication Year :
2017

Abstract

Objective: To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization.<br />Design: Propensity score-matched case-control study using the National Health Insurance data.<br />Participants: A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services.<br />Measurements: Demographic characteristics, functional outcomes (modified Rankin Scale, Barthel Index, Lawton-Brody Instrumental Activities of Daily Living, Functional Oral Intake Scale, Mini-Nutritional Assessment, Berg Balance Test, Usual Gait Speed Test, 6-Minute Walk Test, Fugl-Meyer Assessment (modified sensation and motor), Mini-Mental State Examination, Motor Activity Log, and the Concise Chinese Aphasia Test), subsequent healthcare utilization (90-day stroke re-admission and emergency department visits), and 90-day mortality.<br />Results: After propensity score matching, baseline characteristics, stroke severity, and status of healthcare utilization before index stroke admission were similar between cases and controls. After PAC services, the case group obtained significant improvement in all functional domains and may have reduced subsequent disability. Among all functional assessments, balance was the most significantly improved domain and was suggestive for the reduction of subsequent falls risk and related injuries. Compared with controls, patients receiving PAC services had significantly lower 90-day hospital re-admissions [11.1% vs 21.0%, adjusted odds ratio (aOR) 0.47 with 95% confidence interval (CI) 0.34-0.64], stroke-related re-admissions (2.1% vs 8.8%, aOR 0.22, 95% CI 0.12-0.41), and emergency department visits (13.5% vs 24.0%, aOR 0.49, 95% CI 0.37-0.65), but the 90-day mortality rate remained similar between groups (1.4% case group vs 2.0% control group, aOR 0.68, 95% CI 0.29-1.62).<br />Conclusions: PAC significantly improved the recovery of stroke patients in all functional domains through the program, with universal interorganizational staff training, periodic functional assessment, and high-intensity rehabilitation. Further longitudinal research is needed to evaluate the long-term survival benefits and healthcare utilization.<br /> (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1538-9375
Volume :
18
Issue :
11
Database :
MEDLINE
Journal :
Journal of the American Medical Directors Association
Publication Type :
Academic Journal
Accession number :
28804011
Full Text :
https://doi.org/10.1016/j.jamda.2017.06.020