Dataset Information

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

ABSTRACT:

Background

It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors.

Methods

Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke.

Results

Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p?=?0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p?=?0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p?=?0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p?=?0.032) subgroups respectively, compared to first quarter.

Conclusion

Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.

SUBMITTER: Tyagi S

PROVIDER: S-EPMC6251229 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

Tyagi Shilpa S Koh Gerald Choon-Huat GC Nan Luo L Tan Kelvin Bryan KB Hoenig Helen H Matchar David B DB Yoong Joanne J Finkelstein Eric A EA Lee Kim En KE Venketasubramanian N N Menon Edward E Chan Kin Ming KM De Silva Deidre Anne DA Yap Philip P Tan Boon Yeow BY Chew Effie E Young Sherry H SH Ng Yee Sien YS Tu Tian Ming TM Ang Yan Hoon YH Kong Keng Hee KH Singh Rajinder R Merchant Reshma A RA Chang Hui Meng HM Yeo Tseng Tsai TT Ning Chou C Cheong Angela A Ng Yu Li YL Tan Chuen Seng CS

BMC health services research 20181122 1

<h4>Background</h4>It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with c ...[more]

PMID: 30466417

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Dataset Information

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

Background

Methods

Results

Conclusion

Publications

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

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