Efficacy and Cost over 12 Hospitalization Weeks of Postacute Care for Stroke

Abstract

Few studies have investigated changes in functional outcomes and economic burden in patients in the postacute care cerebrovascular disease (PAC-CVD) program. We, for the first time, retrospectively investigated changes in functional performance and the national health insurance (NHI) cost over 12 PAC-CVD hospitalization weeks and evaluated the therapeutic effects of the PAC-CVD program on the NHI cost. Specifically, the functional outcomes and NHI cost of 263 stroke patients in the PAC-CVD program were analyzed. The repeated measures t test was used to compare functional performance over 0–3 weeks, and a one-way repeated measures multivariate analysis of variance was used to compare functional performance and NHI costs during weeks 0–6 and 0–9. The Wilcoxon signed-rank test was used to compare functional performance over weeks 9–12. Hierarchical multiple regression was used to estimate the effects of functional performance on NHI costs during weeks 3, 6, and 9. Over weeks 0–12, all functional performance measures demonstrated significant improvements. Changes in NHI costs varied depending on whether hospitalization was extended. At any time point, functional performance did not have a significant impact on NHI cost. Therefore, the PAC-CVD program may aid patients with stroke in sustainably regaining functional performance and effectively controlling economic burden.

Effects of functional performance and national health insurance cost on length of hospitalization for postacute care in stroke: a retrospective observational study

“…Several studies have found that age is a factor influencing LOS in the PAC-CVD program, and our study yielded a similar finding; specifically, we discovered that LOS tends to be shorter for older patients than for younger patients [ 12 , 30 , 31 ]. Rehabilitation teams may have lower expectations regarding functional recovery in elderly patients.…”

“…The program enhances patients’ physical function and provides support for their return home or transfer to a long-term care institution. One study found that during 0–12 weeks of hospitalization in the PAC-CVD program, the functional performance of patients significantly improved [ 12 ]. However, longer hospitalization within the PAC-CVD program may result in community hospitals facing a shortage of PAC-CVD beds, which increases the wait time for beds or requires patients to be transferred to a hospital with available beds [ 13 ].…”

“…Regarding NHI costs, under the per-diem reimbursement system, the PAC-CVD program can effectively restore physical function without the patient incurring additional medical expenses [ 12 ]. The present study found that at weeks 3 and 6, NHI costs were significantly associated with the LOS recommended by the PAC-CVD program; thus, higher costs during this period corresponded to a longer stay.…”

“…They also tend to have more ambitious rehabilitation goals than older patients, such as returning to work. Consequently, younger patients have a greater LOS to ensure they reach their rehabilitation goals [ 12 , 30 – 34 ]. In 2019, Taiwan implemented a home-based PAC program that provided an alternative rehabilitation option for patients with stroke in the postacute stage and who were unable to receive hospital care but could still benefit from active rehabilitation.…”

“…The PAC-CVD program sustainably improves patients’ physical function and walking ability over 12 weeks of hospitalization. Medical expenses are controlled through the NHI per-diem reimbursement system (NT$3645 per day) and submission of hospitalization extension applications [ 12 ]. However, in clinical practice, the allocation of medical resources such as length of stay (LOS) given limited bed capacity must be analysed.…”