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

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.

Combined Functional Assessment for Predicting Clinical Outcomes in Stroke Patients After Post-acute Care: A Retrospective Multi-Center Cohort in Central Taiwan

“…However, it should be noted that the greater the PAC LOS, the greater the number of improved rehabilitation assessments. The situation is similar to a previous study in Taiwan showing post-stroke patients having longer stay in a PAC institution have superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function (Tung et al, 2021). Despite an upper limit in the PAC payment for LOS, it was suggested that the disability status of patients should be taken into account in planning PAC with preset rehabilitation goals (Tan et al, 2009(Tan et al, , 2010.…”

A multicenter study to compare the effectiveness of the inpatient post acute care program versus traditional rehabilitation for stroke survivors

“…In 2017, Lai et al reported that 76.8% of stroke patients returned to their homes and communities following the completion of the PAC program in Taiwan 10 . Several factors are associated with the outcomes of patients utilizing the post-stroke PAC program, including the duration of PAC stay 11 and stroke type 12 . However, most hospitals authorized to provide the PAC program in Taiwan also have non-PAC services.…”

Effects of Caregiver’s Gender or Distance Between Caregiver and Patient’s Home on Home Discharge from Hospital in 285 Patients Aged ≥75 Years in Japan

“…Organizing patient transfers through negotiations with other hospitals is reportedly a reason for longer stays in the emergency department [ 41 ]: such transfers are unnecessary in the case of home discharge. Providing home-visit services to complement home discharge would help patients or caregivers achieve earlier discharge [ 42 ]; that would avoid some of the disadvantages caused by shorter hospital stays [ 43 ].…”