Rehabilitative post-acute care for stroke patients delivered by per-diem payment system in different hospitalization paths: A Taiwan pilot study

Wang, Chung-Yuan; Chen, Yu-Ren; Hong, Ji Hong; Chan, Chih-Chun; Chang, Long-Chung; Shi, Hon-Yi

doi:10.1093/intqhc/mzx102

Cited by 26 publications

(47 citation statements)

References 31 publications

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“…The global sensitivity analysis of the weights of signi cant predictors of 30-day readmission in the patients with stroke in this study revealed that the best predictor was PAC. This nding is consistent with earlier reports that, compared to all other stroke treatment variables, PAC has the largest effect on outcome in terms of overall treatment cost, functional status after stroke, and duration of hospital stay before transfer to rehabilitative ward [25,28]. Wang et al coupled a natural experimental design with propensity score matching to assess the impact of PAC in stroke patients and to examine the longitudinal effects of PAC on functional status [25].…”

Section: Discussionsupporting

confidence: 85%

Machine learning algorithms to predict 30-day readmission in patients with stroke: a prospective cohort study

Chen¹,

Chung²,

Yeh³

et al. 2020

Preprint

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Background No studies have discussed machine learning algorithms to predict the risk of 30-day readmission in patients with stroke. The objective of the present study was to compare the accuracy of the artificial neural network (ANN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models and to explore the significant factors in predicting 30-day readmission after stroke. Methods This study prospectively compared the accuracy of the models using clinical data for 1,476 patients with stroke treated in six hospitals between March, 2014 and September, 2019. A training dataset (n=1,033) was used for model development, a testing dataset (n=443) was used for internal validation, and a validating dataset (n=167) was used for external validation. A global sensitivity analysis was performed to compare the significance of the selected input variables. Results Of all forecasting models, the ANN model had the highest accuracy in predicting 30-day readmission after stroke and had the highest overall performance indices. According to the ANN model, 30-day readmission was significantly associated with post-acute care (PAC) program, patient attributes, clinical attributes, and functional status scores before re-habilitation (all P <0.05). Additionally, PAC program was the most significant variable affecting 30-day readmission, followed by nasogastric tube insertion, and stroke type ( P <0.05). Conclusions Comparisons of the five forecasting models indicated that the ANN model had the highest accuracy in predicting 30-day readmission in stroke patients. Before stroke patients are discharged from hospitalization, they should be counseled regarding their potential for recovery and other possible outcomes. These important predictors can also be used to educate candidates for stroke patients who underwent PAC rehabilitation with respect to the course of recovery and health outcomes.

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Section: Discussionsupporting

confidence: 85%

Machine learning algorithms to predict 30-day readmission in patients with stroke: a prospective cohort study

Chen¹,

Chung²,

Yeh³

et al. 2020

Preprint

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“…The average length of stay in PAC in our study is 35.01±16.373 days, which is a little longer than previous data of 25.21~34.11 days admitted in PAC for stroke patients in sub-acute phase 3 . Ischemic stroke accounted for 76.7%(n=148) stroke patients and hemorrhagic type accounted for 23.3% (n=45), which is quite compatible with previous essay indicated in 80% of ischemic stroke and 20% of hemorrhagic stroke in epidemiological prevalence 6 .In our study, stroke patients included 60.6% (n=117) male and 39.4%(n=76) female.…”

Section: Discussioncontrasting

confidence: 68%

“…The PAC program revealed a more economic 2,3 and better recovery strategy 4 for stroke patient after acute phase. Current essay indicate benefits in ADL function, balance/coordination, walking speed, motor and sensory function of upper extremities after PAC hospitalization 1,5 , and in our study, we found all the improvements of BI, BAL, Gait Speed as well as upper sensory and motor function of FMA correlate to longer stays in PAC for stroke patients.…”

Section: Discussionmentioning

confidence: 99%

The Correlation Between the Length of Stay in Post-Acute Care(PAC) and General and Improvements in Stroke Patients

Tung

Cheng

Chou

2019

Preprint

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Background Post-acute care (PAC) is a transitional care following acute medical stage for stroke patients and offering a more intensive rehabilitative program. According to National Health Insurance in Taiwan, only patients encountered acute stroke within one month, under relative stable medical condition and had potential for aggressive rehabilitation could transfer to PAC institution. Stroke patients receive physical, occupational and speech therapy in PAC. However, there’s no research evaluating the effects of PAC for stroke patients ever since the PAC plan inaugurated in Taiwan. Thus, this study aims to investigate whether the duration of hospitalization in PAC correlates to the patients’ improvements. Methods This is a retrospective and single- center study in Taiwan. We collected 193 stroke patients who received acute care at Chi Mei Medical Center, Taiwan during 2014~2017 and recorded their length of stay in PAC. Stroke patients’ functional ability, such as activities of daily living (ADL) function, swallowing ability and so on, as well as their corresponding scales were assessed on the first and last day during PAC hospitalization. Statistical analysis was conducted via SPSS ver21.0. This study was listed on ClinicalTrials.gov(Identification number: NCT03778905). Results The average duration of hospitalization in PAC was 35.01±16.373 days. The longer duration of hospitalization in PAC positively correlates to BI (p=0.000***, R=0.330), BAL(p=0.000***, R=0.461), Gait Speed(p=0.002**, R=0.218), upper sensory function of FMA(p=0.000***, R=0.263) and upper motor function of FMA(p=0.000***, R=0.276) in stroke patients significantly. Conclusion Longer duration of hospitalization in PAC is conducive to enhancing ADL function, advancing balance and coordination, boosting walking speed and augmenting both dexterity and sensory function of upper limb in stroke patients.

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“…10 Candidate patients in acute ward would first be evaluated by a case manager and may participate in the program if they meet the following criteria: (1) stroke onset time within 1 month, (2) stable hemodynamic parameters within 72 h, (3) no neurological deterioration within 72 h, and (4) sufficient cognitive function and ability to learn rehabilitation exercises, more specifically, with modified Rankin Scale (MRS) between 2 and 4 (between 3 and 4 since July 2017 due to the change in policy). 8,20 Patient would be transferred to PAC hospital for rehabilitation, where a hospital-based multidisciplinary team, composed of a physiatrist, physical therapist, occupational therapist, speech therapist, social worker, and case manager, managed the rehabilitation program.…”

Section: Pac-cvd Programmentioning

confidence: 99%

“…Patients with up to 3 weeks (n=53) and 3 to 6 weeks of PAC (n=132) had better initial mRS and BI than those with 6 to 12 weeks of PAC (n=304) (For patients with 0-3w, 3-6w, and 6-12w of PAC, the mRS-I were 3 [3][4], 3 [3][4], and 4 [3][4], respectively, p<0.01; the BI-I were 55 , 55 , 45 , respectively, p<0.01). Patients with up to 3 weeks of PAC had greater BI improvement during the first 3 weeks than those with 3 to 6 weeks and 6 to 12 weeks of PAC (For patients with 0-3w, 3-6w, and 6-12w of PAC, the ΔBI 0−3w were 10 [5-20], 10 [5-15], 10 [0-15], respectively, p=0.03); patients with 3 to 6 weeks of PAC had greater BI improvement during the first 6 weeks than those with 6 to 12 weeks of PAC (ΔBI 0−6w : 15 vs 15 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], p<0.01).…”

Section: Composition Of the Pac-cvd Cohortmentioning

confidence: 99%

<p>Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program</p>

Chu¹,

Chen²,

Chen³

et al. 2020

NDT

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Background: Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation. Methods: This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1-to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures. Results: A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater latephase recovery than their IS counterparts. In IS patients, those with age >75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1-5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score >5; those with Mini-Mental State Examination (MMSE) score ≥24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: −6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement. Conclusion: Subcortical ICH patients have greater functional improvement and greater latephase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.

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Rehabilitative post-acute care for stroke patients delivered by per-diem payment system in different hospitalization paths: A Taiwan pilot study

Abstract: The most effective way to reduce the costs of PAC for stroke patients is to minimize the duration of their hospital stay before transfer to rehabilitative PAC. Because it substantially reduces medical costs, rehabilitative PAC should be considered standard care for stroke patients.

Cited by 26 publications

References 31 publications

Machine learning algorithms to predict 30-day readmission in patients with stroke: a prospective cohort study

Machine learning algorithms to predict 30-day readmission in patients with stroke: a prospective cohort study

The Correlation Between the Length of Stay in Post-Acute Care(PAC) and General and Improvements in Stroke Patients

<p>Functional Recovery Patterns of Hemorrhagic and Ischemic Stroke Patients Under Post-Acute Care Rehabilitation Program</p>

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