Determinants of the Length of Stay in Stroke Patients

Kim, Sang Mi; Hwang, Sung Wan; Oh, Eun-Hwan; Kang, Jung-Kyu

doi:10.1016/j.phrp.2013.10.008

Cited by 25 publications

(27 citation statements)

References 14 publications

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“…Penelitian serupa di unit stroke RS Bethesda Yogyakarta tahun 2012 menyebutkan bahwa lama hari rawat pasien stroke tanpa komplikasi rata-rata 5,8 hari dan dengan komplikasi rata-rata 11,4 hari dan penelitian di rumah sakit tersier di Malaysia <7 hari (6,4 hari) yaitu 66,6% 6 . Lamanya hari dirawat dipengaruhi banyak hal diantaranya tingkat keparahan stroke, komorbid dan komplikasi yang menyertai 6 , adanya tindakan operasi 22 , ketepatan terapi yang diberikan sesuai dengan outcome yang diharapkan dan hasil pemeriksaan penunjang lainnya yang mendukung dalam penegakan diagnosa.…”

Section: Hasil Dan Pembahasanunclassified

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Mazidah

Yasin

Kristina

2019

J. Manaj. dan Pelayanan Farm.

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Cost analysis of chronic diseases in health care facilities during JKN is needed as quality and cost control. Stroke is a high cost, volume, and risk, catastrophic disease that can cause an increase in medical expenses, which requires special attention. The purpose of this study is to provide an overview of real costs and cost components, providing an overview of the direct medical costs and tariff packages of INA-CBGs based on the type of stroke, and the factors that affect direct medical costs. This study is a descriptive-analytic observational study according to the hospital perspective. Data was taken retrospectively. The subjects of the study were adult JKN patients who were aged ≥18 years old with a stroke diagnosis that entered the inclusion criteria. The research variables included age, gender, type of stroke, comorbidity, hospitalization class, length of stay (LOS), and real costs. Data analysis used univariate, bivariate and multivariate analysis. The research results obtained total real costs of Rp. 1,525,236,503 with an average cost of Rp. 4,872,960, the largest cost component was the cost of drugs and BMHP Rp. 402,248,555 (27.21%). The real cost of hemorrhagic strokes is Rp. 572,969,865 and the INA-CBGs tariff package is Rp. 483,804,000, the real cost of ischemic stroke is Rp. 1,107,055,700. There were significant differences in real cost from class factors and length of stay (p-value <0.005). The concluded that the INA-CBGs tariff package is insufficient to finance hospitalized patients with hemorrhagic strokes (-Rp89.165,865), but sufficient for ischemic stroke (+Rp.154,789,069).

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Section: Hasil Dan Pembahasanunclassified

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Mazidah

Yasin

Kristina

2019

J. Manaj. dan Pelayanan Farm.

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“…This discrepancy in findings is most probably due to difficulties in measuring AHI in patients with severe brainstem stroke and differences in patient characteristics between studies. In our study, hemorrhagic stroke patients tended to show a longer period of total hospitalization than ischemic stroke patients, which could be attributed to a comparatively longer period of acute care required for hemorrhagic stroke patients [ 29 ]. While hemorrhagic stroke patients were hospitalized for 5 days more than ischemic stroke patients before transfer to the department of rehabilitation medicine, the length of stay in the rehabilitation unit did not show a significant difference.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Sleep-Disordered Breathing in Subacute Phase of Stroke

et al. 2017

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ObjectiveTo assess the frequency and severity of sleep-disordered breathing (SDB) in subacute stroke patients in Korea.MethodsWe consecutively enrolled subacute stroke patients who were transferred to the Department of Rehabilitation Medicine from February 2016 to August 2016. The inclusion criteria were as follows: diagnosis of the first onset of cerebral infarction or hemorrhage in the brain by computed tomography or magnetic resonance imaging; patients between 18 and 80 years old; and patients admitted within 7 days to 6 months after stroke onset. We evaluated baseline clinical data on patients' admission to the Department of Rehabilitation Medicine. We assessed demographic data, stroke severity, neurologic impairment, cognition and quality of life. We used the Epworth Sleepiness Scale to assess quality of sleep. We used a portable polysomnography to detect SDB.ResultsOf the 194 stroke patients, 76 patients enrolled in this study. We evaluated and included 46 patients in the outcome analysis. The mean apnea-hypopnea index (AHI) was 24.2±17.0 and 31 patients (67.4%) exhibited an AHI ≥15. Those in the SDB group showed a higher National Institutes of Health Stroke Scale, lower Functional Ambulation Category, lower Korean version of Modified Barthel Index, and lower EuroQol five dimensions questionnaire (EQ-5D) at admission. Prevalence and clinical characteristics of SDB did not show significant differences among stroke types or locations.ConclusionSDB is common in subacute stroke patients. SDB must be evaluated after a stroke, particularly in patients presenting severe neurologic impairment.

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“…[ 5 ] The presence of ataxia may increase LOS, [ 6 ] dysphagia, [ 7 ] as well as aphasia, [ 8 ] diabetes, [ 9 ] obesity, [ 10 ] and hypertension. [ 11 ] Besides, recurrent stroke patients have been previously reported requiring longer LOS. [ 12 ]…”

Section: Introductionmentioning

confidence: 99%

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

et al. 2020

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Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission. A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated ( P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models. No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) ( P < .001) and hemiparesis ( P = .0108) (adjusted R 2 = 0.24), 2) cognitive FIM ( P = .002) and severity ( P = .001) (adjusted R 2 = 0.22), and 3) home accessibility ( P = .043) and hemiparesis ( P = 0.032) (adjusted R 2 = 0.19). Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset. Socioeconomic situation was found moderately correlated with total FIM (r = −0.32, P < .0001). When stratifying the patients’ socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group ( P < .001); also significant differences were found between mild and severe groups ( P < .001). A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients. Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.

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Determinants of the Length of Stay in Stroke Patients

Cited by 25 publications

References 14 publications

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Analisis Biaya Penyakit Stroke Pasien Jaminan Kesehatan Nasional di RSUD Blambangan Banyuwangi

Clinical Characteristics of Sleep-Disordered Breathing in Subacute Phase of Stroke

Predicting length of stay in patients admitted to stroke rehabilitation with severe and moderate levels of functional impairments

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