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Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

ABSTRACT:

Abstract

Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive physical, occupational, and speech therapy in PAC facility. However, few studies have evaluated the effects of PAC in poststroke patients since PAC's initiation in Taiwan. Thus, this study aims to investigate whether the length of stay in a PAC institution correlates with patients' improvements.This retrospective and single-center study in Taiwan enrolled 193 poststroke patients who had received acute care at Chi-Mei Medical Center, Taiwan, at any period between 2014 and 2017. Data on their length of stay in the PAC institution were collected. Poststroke patients' functional ability-such as activities of daily living (ADL) function and swallowing ability-as well as their corresponding scales were assessed on the first and last day of PAC stay. Statistical analysis was conducted by SPSS version 21.0 .The average duration of PAC stay was 35.01 ± 16.373 days. Duration of PAC stay was significantly positively correlated with the Barthel index (P < .001), Berg balance test score (P < .001), gait speed (P = .002), and upper sensory function and upper motor function within the Fugl-Meyer Assessment (both P < .001).Poststroke patients with longer stay in a PAC institution had superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function.

SUBMITTER: Tung YJ

PROVIDER: S-EPMC8257905 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

Tung Yu-Ju YJ Huang Chin-Tsan CT Lin Wen-Chih WC Cheng Hsin-Han HH Chow Julie Chi JC Ho Chung-Han CH Chou Willy W

Medicine 20210701 26

<h4>Abstract</h4>Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive ph ...[more]

PMID: 34190196

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Project description:BackgroundOlder adults make up 33% of all trauma admissions in Australia despite comprising 17% of the population with rates rising faster for older age groups compared to any other age group. A high proportion of older adults admitted to hospital following trauma are frail and have increased rates of hospital acquired complications, resulting in poorer outcomes as well as increased resource utilisation and cost to the healthcare system. Length of Stay (LOS) is an important outcome for hospitals, contributing to resource utilisation and patient flow. This study aimed to determine factors associated with the primary outcome of LOS in older persons admitted with trauma at a major trauma centre as targets for improvement.MethodsEthics approval was obtained to collect data on all adult trauma admissions ≥ 1 day in patients aged 65 years and over. Patients were included in the Trauma in older persons (TOPS) database if they otherwise met criteria for the pre-existing trauma registry maintained by the hospital's trauma service. Admissions between January 2022 and January 2023 were included. Univariable negative binomial regression identified variables associated with LOS with p-values ≤ 0.1 which were then included in a multivariable regression model. Significance was taken as p-value ≤ 0.05.Results1250 admissions ≥ 1 day and alive at discharge were included in the primary analysis. The median LOS was 7 (4-13) days. In the multivariable model, delirium (Incidence Rate Ratio (IRR) = 1.41, 95%CI = 1.25-1.59), inpatient fall (IRR = 1.46, 95%CI = 1.15-1.86), pneumonia (IRR = 1.28, 95%CI = 1.08-1.53), thromboembolism (IRR = 1.43, 95%CI = 1.05-1.96), blood transfusion (IRR = 1.34, 95%CI = 1.17-1.53) and unplanned intensive care admission (IRR = 1.52, 95%CI = 1.08-2.14) were all associated with increased LOS. Low fall mechanism was high risk for longer LOS (IRR = 1.26, 95%CI = 1.11-1.43).ConclusionsAfter controlling for available factors, inpatient complications and patients admitted following low falls were identified as high risk for increased LOS and may represent areas for targeted quality improvement for older adults admitted following trauma.

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Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

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Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

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