Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan

Kyoko Murata, Shiro Hinotsu, Nobutake Sadamasa, Kazumichi Yoshida, Sen Yamagata, Shoji Asari, Susumu Miyamoto, Koji Kawakami

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Abstract

Objective: To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Design: Retrospective cohort study. Setting: One acute and one rehabilitation hospital in Japan. Participants: Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Main outcome measures: Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Results: Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). Conclusions: The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.

Original languageEnglish
Article numbermzw127
Pages (from-to)26-31
Number of pages6
JournalInternational Journal for Quality in Health Care
Volume29
Issue number1
DOIs
Publication statusPublished - Feb 1 2017

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Keywords

  • Healthcare costs
  • Hospital care
  • Rehabilitation/long-term care
  • Stroke

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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