Healthcare Utilization for Stroke Patients at the End of Life: Nationally Representative Data

Levy, Sarah; Pedowitz, Elizabeth; Stein, Laura; Dhamoon, Mandip S.

doi:10.1016/j.jstrokecerebrovasdis.2021.106008

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…For the second knowledge gap, knowledge on resource use and costs in the last months of life is only available for a limited number of causes of death, such as circulatory diseases [13], stroke [14], and respiratory diseases [15]. Still, most of the available evidence is on cancer patients' use of secondary care in the last months of life [5-10, 16, 17].…”

Section: Introductionmentioning

confidence: 99%

Healthcare use and costs in the last six months of life by level of care and cause of death

Michel,

Aas,

Augestad

et al. 2024

BMC Health Serv Res

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Background Existing knowledge on healthcare use and costs in the last months of life is often limited to one patient group (i.e., cancer patients) and one level of healthcare (i.e., secondary care). Consequently, decision-makers lack knowledge in order to make informed decisions about the allocation of healthcare resources for all patients. Our aim is to elaborate the understanding of resource use and costs in the last six months of life by describing healthcare use and costs for all causes of death and by all levels of formal care. Method Using five national registers, we gained access to patient-level data for all individuals who died in Norway between 2009 and 2013. We described healthcare use and costs for all levels of formal care—namely primary, secondary, and home- and community-based care —in the last six months of life, both in total and differentiated across three time periods (6-4 months, 3-2 months, and 1-month before death). Our analysis covers all causes of death categorized in ten ICD-10 categories. Results During their last six months of life, individuals used an average of healthcare resources equivalent to €46,000, ranging from €32,000 (Injuries) to €64,000 (Diseases of the nervous system and sense organs). In terms of care level, 63% of healthcare resources were used in home- and community-based care (i.e., in-home nursing, practical assistance, or nursing home care), 35% in secondary care (mostly hospital care), and 2% in primary care (i.e., general practitioners). The amount and level of care varied by cause of death and by time to death. The proportion of home- and community-based care which individuals received during their last six months of life varied from 38% for cancer patients to 92% for individuals dying with mental diseases. The shorter the time to death, the more resources were needed: nearly 40% of all end-of-life healthcare costs were expended in the last month of life across all causes of death. The composition of care also differed depending on age. Individuals aged 80 years and older used more home- and community-based care (77%) than individuals dying at younger ages (40%) and less secondary care (old: 21% versus young: 57%). Conclusions Our analysis provides valuable evidence on how much healthcare individuals receive in their last six months of life and the associated costs, broken down by level of care and cause of death. Healthcare use and costs varied considerably by cause of death, but were generally higher the closer a person was to death. Our findings enable decision-makers to make more informed resource-allocation decisions and healthcare planners to better anticipate future healthcare needs.

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Section: Introductionmentioning

confidence: 99%

Healthcare use and costs in the last six months of life by level of care and cause of death

Michel,

Aas,

Augestad

et al. 2024

BMC Health Serv Res

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“…Sequelae from stroke generally include motor weakness and cognitive impairment [1,2]. Stroke patients with sequelae may suffer from mental health problems, such as depression, suicidal ideation, and suicide attempt [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Stroke Patients with and without Sequelae: A Cross-Sectional Analysis Using the KOREA National Health and Nutrition Examination Survey (2016–2019)

Lee

Nam

et al. 2021

JCM

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(1) Background: We aimed to evaluate the association between sociodemographic factors and mental health problems and the sequelae of stroke in South Korea by analyzing the annual Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2016 to 2019. (2) Methods: Data were obtained from 32,379 participants who participated in the KNHANES (2016–2019). A total of 567 participants diagnosed with stroke were included in this study. Patients were divided into two groups based on the presence of sequelae: (a) stroke patients with sequelae (n = 227, 40.0%) and (b) stroke patients without sequelae (n = 340, 60.0%). (3) Results: Compared to stroke patients without sequelae, those with sequelae were significantly associated with sex (male, 61.2% vs. 47.6%, p = 0.002), household income (lower half, 78.9% vs. 67.4%, p = 0.005), owning a house (60.4% vs. 68.5%, p = 0.048), marital status (unmarried, 7.05% vs. 1.76%, p < 0.001), depression (13.2% vs. 7.35%, p = 0.045), suicidal ideation (6.17% vs. 3.24%, p = 0.010), and suicide attempts (2.64% vs. 0.88%, p = 0.012). (4) Conclusions: Our study showed that poor sociodemographic factors and mental health problems were significantly associated with sequelae from stroke. Clinical physicians should therefore carefully screen for depression and suicidality in stroke patients with sequelae, especially in those with poor sociodemographic factors.

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Understanding the complexity of a stroke care system through functional modelling and analysis

Salehi,

Veitch,

Smith

et al. 2024

Human Factors in Healthcare

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Healthcare Utilization for Stroke Patients at the End of Life: Nationally Representative Data

Cited by 3 publications

References 36 publications

Healthcare use and costs in the last six months of life by level of care and cause of death

Healthcare use and costs in the last six months of life by level of care and cause of death

Comparative Analysis of Stroke Patients with and without Sequelae: A Cross-Sectional Analysis Using the KOREA National Health and Nutrition Examination Survey (2016–2019)

Understanding the complexity of a stroke care system through functional modelling and analysis

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