The Correlation Between the Length of Stay and Improvements in Post Acute Care Stroke Patients

2018 ◽  
Vol 99 (10) ◽  
pp. e29
Author(s):  
Yu-Ju Tung ◽  
Hsin-Han Cheng ◽  
Willy Chou
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Stroke Patients ◽  
Post Acute Care

scholarly journals The Correlation Between the Length of Stay in Post-Acute Care(PAC) and General and Improvements in Stroke Patients

2019 ◽  
Author(s):  
Yu-Ju Tung ◽  
Hsin-Han Cheng ◽  
Willy Chou
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Speech Therapy ◽  
Transitional Care ◽  
Medical Condition ◽  
Medical Center ◽  
Sensory Function ◽  
Stroke Patients ◽  
Duration Of Hospitalization ◽  
Post Acute Care

Abstract Background Post-acute care (PAC) is a transitional care following acute medical stage for stroke patients and offering a more intensive rehabilitative program. According to National Health Insurance in Taiwan, only patients encountered acute stroke within one month, under relative stable medical condition and had potential for aggressive rehabilitation could transfer to PAC institution. Stroke patients receive physical, occupational and speech therapy in PAC. However, there’s no research evaluating the effects of PAC for stroke patients ever since the PAC plan inaugurated in Taiwan. Thus, this study aims to investigate whether the duration of hospitalization in PAC correlates to the patients’ improvements. Methods This is a retrospective and single- center study in Taiwan. We collected 193 stroke patients who received acute care at Chi Mei Medical Center, Taiwan during 2014~2017 and recorded their length of stay in PAC. Stroke patients’ functional ability, such as activities of daily living (ADL) function, swallowing ability and so on, as well as their corresponding scales were assessed on the first and last day during PAC hospitalization. Statistical analysis was conducted via SPSS ver21.0. This study was listed on ClinicalTrials.gov(Identification number: NCT03778905). Results The average duration of hospitalization in PAC was 35.01±16.373 days. The longer duration of hospitalization in PAC positively correlates to BI (p=0.000***, R=0.330), BAL(p=0.000***, R=0.461), Gait Speed(p=0.002**, R=0.218), upper sensory function of FMA(p=0.000***, R=0.263) and upper motor function of FMA(p=0.000***, R=0.276) in stroke patients significantly. Conclusion Longer duration of hospitalization in PAC is conducive to enhancing ADL function, advancing balance and coordination, boosting walking speed and augmenting both dexterity and sensory function of upper limb in stroke patients.

scholarly journals Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching

2021 ◽  
Vol 11 (2) ◽  
pp. 161
Author(s):  
Chong-Chi Chiu ◽  
Jhi-Joung Wang ◽  
Chao-Ming Hung ◽  
Hsiu-Fen Lin ◽  
Hong-Hsi Hsien ◽  
...  
Keyword(s):  
Propensity Score ◽  
Functional Status ◽  
Propensity Score Matching ◽  
Acute Care ◽  
Medical Cost ◽  
Economic Burden ◽  
Stroke Rehabilitation ◽  
Stroke Patients ◽  
The Impact ◽  
Post Acute Care

Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost–illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.

Post acute care: Can hospitals do better with less?

1997 ◽  
Vol 20 (2) ◽  
pp. 43 ◽  
Author(s):  
Gideon A Caplan ◽  
Ann Brown
Keyword(s):  
Cost Effectiveness ◽  
Length Of Stay ◽  
Acute Care ◽  
Early Discharge ◽  
Government Funding ◽  
Discharge From Hospital ◽  
Post Acute Care

Judging by reports in medical magazines and journals, ?early discharge schemes?, bettertermed ?post acute care?, are not popular with doctors. However, government policyencourages earlier discharge from hospital, so that the choice facing clinicians is todischarge patients early with support, or early without support, or deal with theconsequences of length of stay overruns. Fortunately, government funding for post acutecare is increasing. There is a strong rationale for post acute care based on better patientoutcomes and cost-effectiveness, but these desirable results will only be achieved ifscrupulous attention is paid to detail, as embodied in the 10 principles of post acutecare. To function optimally, post acute care should be coordinated by the hospitalwhich provided the acute care.

scholarly journals Post-Acute Care Service use in Lung Cancer Patients

2021 ◽  
Author(s):  
Mitra McLarney ◽  
Frances S. Shofer ◽  
Jasmine Zheng
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Acute Care ◽  
Service Use ◽  
Care Service ◽  
Rehabilitation Service ◽  
Lung Cancer Patients ◽  
Acute Care Service ◽  
Post Acute Care

Abstract Purpose: Lung cancer patients experience functional deconditioning secondary to their underlying cancer and treatment yet rehabilitation service use remains low. The goal of this study is to compare post-acute care service use in lung cancer patients admitted to a metropolitan academic medical center. Methods: Adult lung cancer patients admitted from January 1, 2017 to August 31, 2018 with a diagnosis of lung cancer based on International Classification of Diseases 10, C34.0-C34.9, were included in this study. Patient characteristics including age, gender, race, marital status, functional status on admission, length of stay, and number of comorbidities were compared based on discharge setting. Results: 1,139 lung cancer patients were included in our study. The majority of patients discharged home with home care (51%) followed by home without services (35%), skilled nursing facilities (SNF) (10%) and acute inpatient rehabilitation facilities (IRF) (4%). 44% (498) of patients were primarily admitted for their lung cancer diagnosis. In unadjusted analyses, patients who discharged to SNF compared to home were more likely to be older, black, unmarried, live alone and have died during the study period. Patients who discharged to IRF had longer acute care hospitalization length of stays. In adjusted analyses, age, number of concurrent comorbidities and length of stay significantly correlated with discharge location. Conclusion: Lung cancer patients are unlikely to be discharged to a post-acute care facility after an acute hospitalization. Rehabilitation service use differs by sociodemographic factors, concurrent medical history and functional status. Future study is needed to better understand why these differences in discharge setting persists.

Abstract T P117: Impact of Medicaid Coverage on Utilization of Inpatient Rehabilitation Facilities

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lesli Skolarus ◽  
James F Burke ◽  
Lewis B Morgenstern ◽  
Will Meurer ◽  
Eric Adelman ◽  
...  
Keyword(s):  
Acute Care ◽  
Private Insurance ◽  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Medicaid Coverage ◽  
Random Intercept ◽  
Working Age ◽  
Medicaid Population ◽  
Post Acute Care

Objective: Optimal post-acute care is associated with improved stroke outcomes. Among working age stroke patients discharged to institutional post-acute care, those with Medicaid are less likely to be discharged to an inpatient rehabilitation facility (IRF) than those with private insurance, a finding which may be influenced by state Medicaid coverage. We hypothesized that stroke patients residing in states where Medicaid does not cover IRFs would be less likely to be discharged to an IRF than patients residing in states where Medicaid covers IRFs. Methods: Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample (NIS) using ICD-9 CM codes 433.x1, 434.x1 and 436. Medicaid coverage of IRFs (yes versus no) was ascertained for 45 states with NIS data by review of state Medicaid websites. The primary outcome was discharge to IRF (versus other discharge destinations). We fit a hierarchical logistic regression model that included patient-level factors (demographics and stroke severity measures (length of stay, t-PA use and Charlson comorbidity score)), and a state policy variable representing whether a State’s Medicaid pays for IRF, with a random intercept for hospital. Based on this model, we estimated the probability of utilization of IRFs in states with Medicaid coverage of IRFs compared to those without. Results: Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) out of 45 states. Compared to stroke patients residing in states with Medicaid coverage of IRF, stroke patients hospitalized in states without Medicaid coverage of IRF were less likely to be discharged to an IRF (12.8% (7.5-18.0%) vs. 19.4% (17.0-21.8%), p=0.02) after adjusting for patient and hospital factors. Conclusion: Working age stroke patients with Medicaid who reside in states where Medicaid does not cover IRFs have less utilization of IRFs than patients residing in states where Medicaid covers IRFs. As the Medicaid population expands under the Patient Protection and Affordable Care Act and the number of working age stroke patients increase, careful attention to state Medicaid policy for post-acute care and analysis of its effects are warranted.

Post-acute care regains quality of life among middle-aged and older stroke patients in Taiwan

2019 ◽  
Vol 83 ◽  
pp. 271-276 ◽  
Author(s):  
Li-Ning Peng ◽  
Li-Ju Chen ◽  
Wan-Hsuan Lu ◽  
Shu-Ling Tsai ◽  
Liang-Kung Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acute Care ◽  
Middle Aged ◽  
Stroke Patients ◽  
Post Acute Care

scholarly journals Rehabilitative post-acute care for stroke patients delivered by per-diem payment system in different hospitalization paths: A Taiwan pilot study

2017 ◽  
Vol 29 (6) ◽  
pp. 779-784 ◽  
Author(s):  
Chung-Yuan Wang ◽  
Yu-Ren Chen ◽  
Jia-Pei Hong ◽  
Chih-Chun Chan ◽  
Long-Chung Chang ◽  
...  
Keyword(s):  
Pilot Study ◽  
Acute Care ◽  
Payment System ◽  
Stroke Patients ◽  
Post Acute Care

scholarly journals Association of the FRAIL scale with rehabilitation outcomes in the community hospital setting

2021 ◽  
Author(s):  
J Jiang ◽  
YYA Han ◽  
J Goh
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Community Hospital ◽  
Hospital Setting ◽  
Frailty Status ◽  
Rehabilitation Outcomes ◽  
Adverse Health Outcomes ◽  
Frail Patients ◽  
Functional Gain ◽  
Post Acute Care

Introduction: Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale. In Singapore, its use has been studied in tertiary hospitals but not in community hospitals. A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources. We aimed to determine whether the FRAIL scale is associated with rehabilitation outcomes in patients admitted to the community hospital setting, where post-acute care and rehabilitation are primarily delivered. Methods: This was a retrospective cohort study. The FRAIL scale was utilised to screen 560 older adults who were admitted to a community hospital for rehabilitation. Data were analysed to determine the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay and discharge destination. Results: The combined score of the FRAIL scale showed significant negative association with absolute functional gain (p < 0.001), rehabilitation effectiveness (p < 0.001) and rehabilitation efficiency (p < 0.001), whereas it was positively associated with increased length of stay (p < 0.05) and a need for continued support in increased care settings (p < 0.001). Individual components of the FRAIL scale, in particular, the ‘fatigue’, ‘ambulation’ and ‘loss of weight’ components, appeared to be highly associated with rehabilitation effectiveness and efficiency, especially among pre-frail patients. Conclusion: The utility of the FRAIL scale as an indicator of frailty status and its association with rehabilitative outcomes in the post-acute care setting were demonstrated. Moreover, the FRAIL scale may better predict the rehabilitative progress of pre-frail patients.

Regional disparities in acute and post-acute care of stroke patients in France, 2015

2018 ◽  
Vol 174 (7-8) ◽  
pp. 555-563 ◽  
Author(s):  
C. de Peretti ◽  
A. Gabet ◽  
C. Lecoffre ◽  
P. Oberlin ◽  
Valérie Olié ◽  
...  
Keyword(s):  
Acute Care ◽  
Regional Disparities ◽  
Stroke Patients ◽  
Post Acute Care

scholarly journals Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie

2018 ◽  
Vol 5 (1) ◽  
pp. 25-34
Author(s):  
Antoinette Conca ◽  
Doaa Ebrahim ◽  
Sandra Noack ◽  
Angela Gabele ◽  
Helen Weber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Social Workers ◽  
Acute Care ◽  
Discharge Planning ◽  
Control Period ◽  
Stepped Wedge ◽  
Intervention Period ◽  
Care Needs ◽  
Cluster Randomized ◽  
Post Acute Care

AbstractBackgroundElderly patients often need post-acute care after hospital discharge. Involvement of social workers can positively affect the discharge planning process.AimTo investigate the effect of screening patients at risk for post-acute care needs by social workers on time with respect to social workers’ notification, length of stay and delays in discharge compared to usual care.MethodsCluster randomized stepped wedge trial design for five clusters (wards) and two steps (control to intervention) was used. A total of 400 patients (200 per period) with high risk of post-acute care needs (defined as Post-Acute Care Discharge score, PACD ≥ 7) were included. Social workers performed a screening to decide about self-referral to their services (intervention period), which was compared to a highly structured standard SW notification by physicians and nurses (control period). A Generalized Estimating Equations model adjusted the clustering and baseline differences.ResultsA total of 139 patients were referred to social services (intervention: n = 76; control: n = 63). Time to social workers’ notification was significantly shorter in the intervention period when adjusted for all the differences in baseline (Mdn 1.2 vs 1.7, Beta = -0.73, 95%-CI 1.39 to -0.09). Both the length of stay and the delayed discharge time in nights showed no significant differences (Mdn 10.0 vs 9.1, Beta = -0.12, 95%-CI 0.46 to .22 nights 95%-CI, resp. Mdn 0.0 vs 0.0, Beta = .11, 95%-CI -0.64 to 0.86).ConclusionScreening speeded up social workers’ notification but did not accelerate the discharge processes. The screening by social workers might show process improvement in settings with less structured discharge planning.

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