Care Trajectories of Veterans in the 12 Months After Hospitalization for Acute Ischemic Stroke

Abstract

Background— Recovery after a stroke varies greatly between individuals and is reflected by wide variation in the use of institutional and home care services. This study sought to classify veterans according to their care trajectories in the 12 months after hospitalization for ischemic stroke. Methods and Results— The sample consisted of 3811 veterans hospitalized for ischemic stroke in Veterans Health Administration facilities in 2007. Three outcomes—nursing home care, home care, and mortality—were modeled jointly >12 months using latent class growth analysis. Data on Veterans’ care use and cost came from the Veterans Administration and Medicare. Covariates included stroke severity (National Institutes of Health Stroke Scale), functional status (functional independence measure score), age, marital status, chronic conditions, and prestroke ambulation. Five care trajectories were identified: 49% of Veterans had Rapid Recovery with little or no use of care; 15% had a Steady Recovery with initially high nursing home or home care that tapered off; 9% had Long-Term Home Care; 13% had Long-Term Nursing Home Care; and 14% had an Unstable trajectory with multiple transitions between long-term and acute care settings. Care use was greatest for individuals with more severe strokes, lower functioning at hospital discharge, and older age. Average annual costs were highest for individuals with the Long-Term Nursing Home trajectory ($63 082), closely followed by individuals with the Unstable trajectory ($58 720). Individual with the Rapid Recovery trajectory had the lowest costs ($9271). Conclusions— Care trajectories after stroke were associated with stroke severity and functional dependency and they had a dramatic impact on subsequent costs.

A retrospective cohort study of high-impact users among patients with cerebrovascular conditions

“… 14 15 In a recent study, five subgroups of patients were identified based on the pattern of recovery following stroke, each with a distinct prognosis and risk of mortality. 16 Similar observations are present in patients with other conditions such as surgery and heart failure. 17 18 It has been suggested that more than half of the high-risk users decreased their use of the healthcare visits after 1 year and a smaller proportion of the high-risk patients persistently and increasingly used healthcare services throughout the 4-year follow-up.…”

Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories

“…However, employing appropriate methods to describe and propose a comprehensive visualization of longitudinal patterns of events, without altering the integrity of real patients' journey through the healthcare system, remains challenging. In recent years, several data mining and statistical approaches have been proposed to extract patterns from sequential data of CTs, such as formal concept analysis [15], latent class analysis [16,17], neural network [18], multi-state Markov model [12] and exponential proportional hazards mixture model [19]. However, getting the picture of complex temporal event sequences is not straightforward for non-experts, despite the variety of strategies available to develop visual analytic tools and graph-based approaches [20][21][22].…”

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors

“…Temporal trends of index-stroke hospitalization [ 15 ], recurrent stroke admissions [ 16 , 17 ], inpatient rehabilitation utilization [ 18 ] and associated risk factors [ 19 ] have been described previously, however papers studying post-stroke care trajectories are sparse [ 20 ]. Focusing on the index stroke admission, researchers explored the temporal trends over a decade in UK setting and further explored the influence of patient socio-demographic (race and age) and functional characteristics on inpatient acute care and indicators of provision of rehabilitation [ 21 ].…”