scholarly journals Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program

2020 ◽  
Vol Volume 16 ◽  
pp. 1975-1985
Author(s):  
Chan-Lin Chu ◽  
Yueh-Peng Chen ◽  
Carl CP Chen ◽  
Chih-Kuang Chen ◽  
Hsiang-Ning Chang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Functional Recovery ◽  
Rehabilitation Program ◽  
Stroke Patients ◽  
Post Acute Care

Abstract P295: The Effect of Endovascular Procedure and Tissue Plasminogen Activator Treatments on 90 Days Episode Payments Among Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raed Hailat ◽  
Monica Yost ◽  
Michael Thompson ◽  
James Burke ◽  
Mathew J Reeves
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Acute Care ◽  
Care Utilization ◽  
Stroke Patients ◽  
Treatment Groups ◽  
Tissue Plasminogen ◽  
Post Acute Care

Introduction: Endovascular therapy (EVT) and tissue plasminogen activator (tPA) are highly effective treatments but little is published on their impact on health care utilization and payments. We analyzed of data from the Michigan Value Collaborative (MVC) registry to compare 90-day episode payments for EVT and tPA treatments acute ischemic stroke patients. Methods: The MVC registry uses claims data from Michigan residents insured by Medicare fee-for-service and Blue Cross Blue Shield, to construct risk-adjusted and price-standardized payments for 90-day episodes of care. Total payments are categorized into index hospitalization, professional services, readmissions, and post-acute care. All ischemic stroke admissions between January 2014 and June 2019 were identified and then categorized using a combination of diagnosis and procedure codes into 3 mutually exclusive treatment groups: EVT (with and without tPA), IV or IA tPA only, and all other ischemic strokes (non EVT-tPA). We compared 90-day episode payments between the 3 groups using analysis of variance and Tukey’s pairwise comparisons. Results: We identified 47,235 acute ischemic stroke patients admitted to 83 Michigan hospitals, 1,775 (3.8%), 4,889 (10.3%), and 40,571 (85.9%) received EVT, tPA only, or neither, respectively. Statistically significant differences were observed across the 3 treatment groups in all payment categories. EVT treated patients had the highest 90-day mean payments in all categories, but particularly for readmissions and post-acute care (Table). tPA treated patients had significantly higher costs than the non EVT-tPA group for total payments, professional and hospitalization fees. Conclusions: EVT and tPA treatments significantly affect 90-day episode payments - primarily due to higher hospitalization and professional payments. Higher readmission and post-acute cost in EVT treated patients reflect higher readmission rates and use of in-patient rehabilitation.

scholarly journals Comparison of Cost-Effectiveness between Inpatient and Home-Based Post-Acute Care Models for Stroke Rehabilitation in Taiwan

2021 ◽  
Vol 18 (8) ◽  
pp. 4129
Author(s):  
Yu-Ju Tung ◽  
Wen-Chih Lin ◽  
Lin-Fu Lee ◽  
Hong-Min Lin ◽  
Chung-Han Ho ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Care ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Transitional Care ◽  
Medical Expenditure ◽  
Stroke Patients ◽  
Home Based ◽  
Pac Model ◽  
Post Acute Care

Stroke rehabilitation focuses on alleviating post-stroke disability. Post-acute care (PAC) offers an intensive rehabilitative program as transitional care following acute stroke. A novel home-based PAC program has been initiated in Taiwan since 2019. Our study aimed to compare the current inpatient PAC model with a novel home-based PAC model in cost-effectiveness and functional recovery for stroke patients in Taiwan. One hundred ninety-seven stroke patients eligible for the PAC program were divided into two different health interventional groups. One received rehabilitation during hospitalization, and the other received rehabilitation by therapists at home. To evaluate the health economics, we assessed the total medical expenditure on rehabilitation using the health system of Taiwan national health insurance and performed cost-effectiveness analyses using improvements of daily activity in stroke patients based on the Barthel index (BI). Total rehabilitative duration and functional recovery were also documented. The total rehabilitative cost was cheaper in the home-based PAC group (p < 0.001), and the cost-effectiveness is USD 152.474 ± USD 164.661 in the inpatient group, and USD 48.184 ± USD 35.018 in the home group (p < 0.001). Lesser rehabilitative hours per 1-point increase of BI score was noted in the home-PAC group with similar improvements in daily activities, life quality and nutrition in both groups. Home-based PAC is more cost-effective than inpatient PAC for stroke rehabilitation.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

scholarly journals Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

2021 ◽  
Vol 13 (1) ◽  
pp. 46-58
Author(s):  
João Paulo Branco ◽  
Filipa Rocha ◽  
João Sargento-Freitas ◽  
Gustavo C. Santo ◽  
António Freire ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Upper Limb ◽  
Functional Recovery ◽  
Prospective Observational Study ◽  
Positive Impact ◽  
Rehabilitation Program ◽  
Patient Functioning ◽  
The Impact

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

scholarly journals Acute Care of Ischemic Stroke Patients in the Hospital

2015 ◽  
Vol 35 (06) ◽  
pp. 629-637
Author(s):  
Ahmad Thabet ◽  
S. Josephson ◽  
Karl Meisel
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Stroke Patients

scholarly journals Post–Acute Care Data for Predicting Readmission After Ischemic Stroke: A Nationwide Cohort Analysis Using the Minimum Data Set

2015 ◽  
Vol 4 (9) ◽  
Author(s):  
Corey R. Fehnel ◽  
Yoojin Lee ◽  
Linda C. Wendell ◽  
Bradford B. Thompson ◽  
N. Stevenson Potter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Care ◽  
Cohort Analysis ◽  
Minimum Data Set ◽  
Data Set ◽  
Minimum Data ◽  
Post Acute Care
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