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

and the, Mei Ju Chi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Design Propensity score-matched case-control study using the National Health Insurance data. Participants A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. 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. 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). 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.

Original languageEnglish
Pages (from-to)990.e7-990.e12
JournalJournal of the American Medical Directors Association
Volume18
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

Fingerprint

Subacute Care
Propensity Score
Taiwan
Stroke
Delivery of Health Care
Mortality
Odds Ratio
Confidence Intervals
Hospital Emergency Service
Nutrition Assessment
Neuropsychological Tests
National Health Programs
Activities of Daily Living
Case-Control Studies
Motor Activity
Rehabilitation
Demography

Keywords

  • functional outcomes
  • healthcare utilization
  • mortality
  • postacute care
  • Stroke

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

@article{93e568fb7a7a4e40a95ddaa8c4dc1337,
title = "Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan: A Nationwide Propensity Score-matched Study",
abstract = "Objective To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Design Propensity score-matched case-control study using the National Health Insurance data. Participants A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. 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. 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). 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.",
keywords = "functional outcomes, healthcare utilization, mortality, postacute care, Stroke",
author = "{and the} and Peng, {Li Ning} and Lu, {Wan Hsuan} and Liang, {Chih Kuang} and Chou, {Ming Yueh} and Chung, {Chih Ping} and Tsai, {Shu Ling} and Chen, {Zhi Jun} and Hsiao, {Fei Yuan} and Chen, {Liang Kung} and Lin, {Chu Sheng} and Tung, {Heng Hsin} and Yang, {Yea Ru} and Chi, {Mei Ju} and Chi, {Mei Ju} and Lee, {Wei Ju}",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/j.jamda.2017.06.020",
language = "English",
volume = "18",
pages = "990.e7--990.e12",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier Inc.",
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TY - JOUR

T1 - Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan

T2 - A Nationwide Propensity Score-matched Study

AU - and the

AU - Peng, Li Ning

AU - Lu, Wan Hsuan

AU - Liang, Chih Kuang

AU - Chou, Ming Yueh

AU - Chung, Chih Ping

AU - Tsai, Shu Ling

AU - Chen, Zhi Jun

AU - Hsiao, Fei Yuan

AU - Chen, Liang Kung

AU - Lin, Chu Sheng

AU - Tung, Heng Hsin

AU - Yang, Yea Ru

AU - Chi, Mei Ju

AU - Chi, Mei Ju

AU - Lee, Wei Ju

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Design Propensity score-matched case-control study using the National Health Insurance data. Participants A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. 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. 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). 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.

AB - Objective To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Design Propensity score-matched case-control study using the National Health Insurance data. Participants A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. 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. 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). 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.

KW - functional outcomes

KW - healthcare utilization

KW - mortality

KW - postacute care

KW - Stroke

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U2 - 10.1016/j.jamda.2017.06.020

DO - 10.1016/j.jamda.2017.06.020

M3 - Article

AN - SCOPUS:85028354286

VL - 18

SP - 990.e7-990.e12

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

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