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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-12

AUTHORS

Shilpa Tyagi, Gerald Choon-Huat Koh, Luo Nan, Kelvin Bryan Tan, Helen Hoenig, David B. Matchar, Joanne Yoong, Eric A. Finkelstein, Kim En Lee, N. Venketasubramanian, Edward Menon, Kin Ming Chan, Deidre Anne De Silva, Philip Yap, Boon Yeow Tan, Effie Chew, Sherry H. Young, Yee Sien Ng, Tian Ming Tu, Yan Hoon Ang, Keng Hee Kong, Rajinder Singh, Reshma A. Merchant, Hui Meng Chang, Tseng Tsai Yeo, Chou Ning, Angela Cheong, Yu Li Ng, Chuen Seng Tan

ABSTRACT

BACKGROUND: It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS: Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS: Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. CONCLUSION: Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices. More... »

PAGES

881

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12913-018-3696-3

DOI

http://dx.doi.org/10.1186/s12913-018-3696-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1110132960

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30466417


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