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.

scholarly journals Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status

2019 ◽  
Vol 8 (8) ◽  
pp. 1233 ◽  
Author(s):  
Chung-Yuan Wang ◽  
Hong-Hsi Hsien ◽  
Kuo-Wei Hung ◽  
Hsiu-Fen Lin ◽  
Hung-Yi Chiou ◽  
...  
Keyword(s):  
Experimental Design ◽  
Propensity Score ◽  
Functional Status ◽  
Acute Care ◽  
Referral System ◽  
Hospital Transfer ◽  
Transfer Group ◽  
Medical Referral ◽  
The Impact ◽  
Post Acute Care

Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study coupled a natural experimental design with PSM to assess the impact of a medical referral system in stroke patients and to examine the longitudinal effects of the system on functional status. The intervention was a hospital-based, function oriented, 12-week to 1-year rehabilitative PAC intervention for patients with cerebrovascular diseases. The average duration of PAC in the intra-hospital transfer group (31.52 days) was significantly shorter than that in the inter-hospital transfer group (37.1 days) (p < 0.001). The intra-hospital transfer group also had better functional outcomes. The training effect was larger in patients with moderate disability (Modified Rankin Scale, MRS = 3) and moderately severe disability (MRS = 4) compared to patients with slight disability (MRS = 2). Intensive post-stroke rehabilitative care delivered by per-diem payment is effective in terms of improving functional status. To construct a vertically integrated medical system, strengthening the qualified local hospitals with PAC wards, accelerating the inter-hospital transfer, and offering sufficient intensive rehabilitative PAC days are the most essential requirements.

scholarly journals Comparison of Cost-Effectiveness between Inpatient and Home-Based Post-Acute Care Models for Stroke Rehabilitation in Taiwan

2021 ◽  
Vol 18 (8) ◽  
pp. 4129
Author(s):  
Yu-Ju Tung ◽  
Wen-Chih Lin ◽  
Lin-Fu Lee ◽  
Hong-Min Lin ◽  
Chung-Han Ho ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Care ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Transitional Care ◽  
Medical Expenditure ◽  
Stroke Patients ◽  
Home Based ◽  
Pac Model ◽  
Post Acute Care

Stroke rehabilitation focuses on alleviating post-stroke disability. Post-acute care (PAC) offers an intensive rehabilitative program as transitional care following acute stroke. A novel home-based PAC program has been initiated in Taiwan since 2019. Our study aimed to compare the current inpatient PAC model with a novel home-based PAC model in cost-effectiveness and functional recovery for stroke patients in Taiwan. One hundred ninety-seven stroke patients eligible for the PAC program were divided into two different health interventional groups. One received rehabilitation during hospitalization, and the other received rehabilitation by therapists at home. To evaluate the health economics, we assessed the total medical expenditure on rehabilitation using the health system of Taiwan national health insurance and performed cost-effectiveness analyses using improvements of daily activity in stroke patients based on the Barthel index (BI). Total rehabilitative duration and functional recovery were also documented. The total rehabilitative cost was cheaper in the home-based PAC group (p < 0.001), and the cost-effectiveness is USD 152.474 ± USD 164.661 in the inpatient group, and USD 48.184 ± USD 35.018 in the home group (p < 0.001). Lesser rehabilitative hours per 1-point increase of BI score was noted in the home-PAC group with similar improvements in daily activities, life quality and nutrition in both groups. Home-based PAC is more cost-effective than inpatient PAC for stroke rehabilitation.

scholarly journals Adoption of improved agricultural technology and its impact on household income: a propensity score matching estimation in eastern Ethiopia

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Muluken G. Wordofa ◽  
Jemal Y. Hassen ◽  
Getachew S. Endris ◽  
Chanyalew S. Aweke ◽  
Dereje K. Moges ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Technology Use ◽  
Household Income ◽  
Agricultural Technology ◽  
Primary Data ◽  
Farm Income ◽  
Agricultural Technologies ◽  
Eastern Ethiopia ◽  
The Impact

Abstract Background Adoption of improved agricultural technologies remains to be a promising strategy to achieve food security and poverty reduction in many developing countries. However, there are limited rigorous impact evaluations on the contributions of such technologies on household welfare. This paper investigates the impact of improved agricultural technology use on farm household income in eastern Ethiopia. Methods Primary data for the study was obtained from a random sample of 248 rural households, 119 of which are improved technology users and the rest are non-users. The research employed the Propensity Score Matching (PSM) procedure to establish the causal relationship between adoption of improved crop and livestock technologies and changes in farm income. Results Results from the econometric analysis show that households using improved agricultural technologies had, on average, 23,031.28 Birr (Birr is the official currency of Ethiopia. The exchange rate according to the National Bank of Ethiopia (NBE) was 1 USD = 27.6017 Birr on 04 October 2018.) higher annual farm income compared to those households not using such technologies. Our findings highlight the importance of promoting multiple and complementary agricultural technologies among rural smallholders. Conclusions We suggest that rural technology generation, dissemination and adoption interventions be strengthened. Moreover, the linkage among research, extension, universities and farmers needs to be enhanced through facilitating a multistakeholders innovation platforms.

Was it worth it? The impact of the German minimum wage on union membership of employees

2021 ◽  
pp. 0143831X2110358
Author(s):  
Simon Ress ◽  
Florian Spohr
Keyword(s):  
Propensity Score ◽  
Social Security ◽  
Labour Market ◽  
Propensity Score Matching ◽  
Minimum Wage ◽  
Trade Union ◽  
Union Membership ◽  
Difference In Differences ◽  
German Trade ◽  
The Impact

This contribution scrutinises how introducing a statutory minimum wage of EUR 8.50 per hour, in January 2015, impacted German employees’ decision with regard to union membership. Based on representative data from the Labour Market and Social Security panel, the study applies a logistic difference-in-differences propensity score matching approach on entries into and withdrawals from unions in the German Trade Union Confederation (Deutscher Gewerkschaftsbund, DGB). The results show no separate effect on withdrawals from or entries into unions after the minimum wage introduction for those employees who benefited financially from it, but a significant increase of entries overall. Thus, unions’ campaign for a minimum wage strengthened their position in total but did not reverse the segmentation of union membership patterns.

RecoverNow: A patient perspective on the delivery of mobile tablet-based stroke rehabilitation in the acute care setting

2018 ◽  
Vol 14 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Karen Mallet ◽  
Rany Shamloul ◽  
Michael Pugliese ◽  
Emma Power ◽  
Dale Corbett ◽  
...  
Keyword(s):  
Acute Care ◽  
Stroke Rehabilitation ◽  
Care Setting ◽  
Hand Function ◽  
Occupational Therapists ◽  
Fine Motor ◽  
Stroke Patients ◽  
Acute Setting ◽  
Cognitive Therapies ◽  
Mobile Tablets

Background/aim We previously reported the feasibility of RecoverNow (a mobile tablet-based post-stroke communication therapy in acute care). RecoverNow has since expanded to include fine motor and cognitive therapies. Our objectives were to gain a better understanding of patient experiences and recovery goals using mobile tablets. Methods Speech-language pathologists or occupational therapists identified patients with stroke and communication, fine motor, or cognitive/perceptual deficits. Patients were provided with iPads individually programmed with applications based on assessment results, and instructed to use it at least 1 h/day. At discharge, patients completed a 19-question quantitative and open-ended engagement survey addressing intervention timing, mobile device/apps, recovery goals, and therapy duration. Results Over a six-month period, we enrolled 33 participants (three did not complete the survey). Median time from stroke to initiation of tablet-based therapy was six days. Patients engaged in therapy on average 59.6 min/day and preferred communication and hand function therapies. Most patients (63.3%) agreed that therapy was commenced at a reasonable time, although half expressed an interest in starting sooner, 66.7% reported that using the device 1 h/day was enough, 64.3% would use it after discharge, and 60.7% would use it for eight weeks. Sixty-seven percent of patients expressed a need for family/friend/caregiver to help them use it. Conclusion Our results suggest that stroke patients are interested in mobile tablet-based therapy in acute care. Patients in the acute setting prefer to focus on communication and hand therapies, are willing to begin within days of their stroke and may require assistance with the tablets.

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