Patterns of Acute Hospital Care, Rehabilitation, and Discharge Disposition after Acute Stroke: The Perth Community Stroke Study 1989–1990

Abstract

There have been few attempts to determine, for a defined population, the total number of patients admitted to hospital and requiring rehabilitation after acute stroke. In a population-based stroke register (the Perth Community Stroke Study) of 492 patients with acute stroke, 70% were admitted to hospital immediately after onset while another 10% were already in-patients for other reasons. The independent predictors of acute management outside hospital were residence in a nursing home [odds ratio (OR) 5.0, 95% confidence interval (CI) 1.8, 13.5], and age 85 years and over (OR 3.1; 95% CI 1.0, 9.0). The average length of stay in hospital was 32 days, (median 18, range 1–212 days), 23 days for acute beds and 55 days for rehabilitation beds. The in-hospital case fatality was 28% (95% CI 24%, 32%). Of the 302 patients discharged from hospital, 248 (82%) returned to their pre-morbid living arrangements. Failure to return home was related to the severity of the stroke (loss of consciousness and severe paresis) and social factors (living alone and pre-morbid disability). We estimate that patients with stroke, one third of whom are aged over 75 years, account for approximately 4% of the total acute bed capacity in metropolitan Perth. The data emphasise the need for hospital-based stroke services to be well organised and to have strong links with community services.

Cost of Stroke in Australia From a Societal Perspective

“…These participation rates were substantially less than the 73.4% and 53.9% that were the general workforce participation rates for men and women in Australia in May 1997. 42 The small indirect costs are consistent with the age of onset of stroke (most cases occur in those of retirement age) and also with the notion that stroke cases in general have more prestroke disability than people of the same age and sex among the general population 40,43,44 and thus are unlikely to have the same prestroke workforce participation as the general population of same sex and age. The high level of preexisting disability among stroke patients is also evident when the costs of community services for first-ever-in-alifetime cases are considered (0.1% of first year costs).…”

“…34 However, there is evidence that the patterns of provision of rehabilitation services vary across Australia. 39,40 Consequently, the rehabilitation costs presented in this study may not be generalizable across all states. Despite this, the relative importance of rehabilitation costs as a contribution to the total costs of stroke has not been previously recognized.…”

Home or Hospital for Stroke Rehabilitation? Results of a Randomized Controlled Trial

“…3 In most developed countries, there is a heavy reliance on hospitals for the acute care and rehabilitation of patients with stroke, whereas the promotion of community services for these purposes is limited. 4,5 A strong argument in favor of admission to hospital after the onset of stroke is the potential benefit for some patients of rapid access to an accurate diagnosis and immediate treatments 6,7 and nursing care and multidisciplinary rehabilitation, which are often more readily available in hospital than at home.…”

Recurrent ischaemic stroke hospitalisations: A retrospective cohort study using Western Australia linked patient records

“…An ischaemic stroke diagnosis was recognised by the following ICD9-CM codes (before July 1999) [8] and ICD10-AM codes (after July 1999) [9]: 433x1 (x ¼ 0,1,2,3, 8,9), 434x1 (x ¼ 0, 1,9), 436, I63x (x ¼ 0, 1,2,3,4,5,6,8,9) and I64. Prior to 1 July 1995, coding of ischaemic stroke cases did not differentiate between ischaemic cerebrovascular disease with or without infarction of the brain.…”

“…Around 70% of acute stroke events result in hospitalisation [2] and of all cardiovascular patients those suffering stroke experience the longest length of stay [1]. The components of acute stroke care include accurate diagnosis, minimisation of pre-hospital delay, therapeutic treatments of stroke to minimise stroke recurrence or occurrence of other vascular problems, provision of nursing care and early rehabilitation during the acute phase, and coordination of discharge planning [3].…”