Dataset Information

First year post-stroke healthcare costs and fall-status among those discharged to the community.

ABSTRACT:

Introduction

Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community.

Patients and methods

Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly calendars and post-discharge interviews. Cost of stroke was estimated for each participant from hospital admission for one year. The association of fall-status with overall cost was tested with multivariable linear regression analysis adjusting for pre-stroke function, stroke severity, age and living situation.

Results

A total of 109 stroke survivors with complete follow-up data (mean age?=?68.5 years (SD?=?13.5 years)) were included. Fifty-three participants (49%) fell following stroke, of whom 28 (26%) had recurrent falls. Estimated mean total healthcare cost was €20,244 (SD=€23,456). The experience of one fall and recurrent falls was independently associated with higher costs of care (p?=?0.02 and p?DiscussionThe observed relationship between falls and cost is likely to be underestimated as aids and adaptions, productivity losses, and nursing home care were not included.

Conclusion

This study points at differences across fall-status in several healthcare costs categories, namely the index admission, secondary/tertiary care (including inpatient re-admissions) and allied healthcare. Future research could compare the cost-effectiveness of inpatient versus community-based fall-prevention after stroke. Further studies are also required to inform post-stroke bone-health management and fracture-risk reduction.

SUBMITTER: Walsh ME

PROVIDER: S-EPMC6453204 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

First year post-stroke healthcare costs and fall-status among those discharged to the community.

Walsh Mary E ME Sorensen Jan J Galvin Rose R Williams David Jp DJ Harbison Joseph A JA Murphy Sean S Collins Ronan R McCabe Dominick Jh DJ Crowe Morgan M Horgan N Frances NF

European stroke journal 20180315 3

<h4>Introduction</h4>Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community.<h4>Patients and methods</h4>Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly ...[more]

PMID: 31008356

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Project description:Given the paucity of longitudinal data in gait recovery after stroke, we compared temporospatial gait characteristics of stroke patients during subacute (<2 months post-onset, T0) and at approximately 6 and 12 months post-onset (T1 and T2, respectively) and explored the relationship between gait characteristics at T0 and the changes in gait speed from T0 to T1. Forty-six participants were assessed at T0 and a subsample of twenty-four participants were assessed at T2. Outcome measures included Fugl-Meyer lower-extremity motor score, 14 temporospatial gait parameters, and symmetry indices of 5 step parameters. Except for step width, all temporospatial parameters improved from T0 to T1 (p ≤ 0.0001). Additionally, significant improvements in symmetry were found for the initial double-support time and single-support time (p ≤ 0.0001). As a group, no significant differences were found between T1 and T2 in any of the temporospatial measures. However, the individual analysis revealed that 42% (10/24) of the subsample showed a significant increase in gait speed (Welch's t-test, p ≤ 0.002). Yet, only 5/24 (21%) of the participants improved speed from T1 to T2 according to speed-based minimum detectable change criteria. The increase in gait speed from T0 to T1 was negatively correlated with gait speed and stride length and positively correlated with the symmetry indices of stance and single-support times at T0 (p ≤ 0.002). Temporospatial gait parameters and stance time symmetry improved over the first 6 months after stroke with an apparent plateau thereafter. A greater increase in gait speed during the first 6 months post-stroke is associated with initially slower walking, shorter stride length, and more pronounced asymmetry in stance and single-support times. The improvement in lower-extremity motor function and bilateral improvements in step parameters collectively suggest that gait changes over the first 6 months after stroke are likely due to a combination of neurological recovery, compensatory strategies, and physical therapy received during that time.

Project description:BackgroundIt 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.MethodsPatient 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.ResultsFive 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.ConclusionHighlighting 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.

Dataset Information

First year post-stroke healthcare costs and fall-status among those discharged to the community.

Introduction

Patients and methods

Results

Conclusion

Publications

First year post-stroke healthcare costs and fall-status among those discharged to the community.

Similar Datasets

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