Quantification of Resource Utilization to Obtain Functional Recovery in Strokes.

Abstract

Background: The increasing elderly population will turn increased attention to the functional recovery and costs for patients with cerebrovascular disease (CVD). Several functional scales like the Barthel index (BI) have been applied in healthcare research and handled as continuous variables for risk adjustment or main outcomes. BI is originally an ordinal variable and we tested whether healthcare resources during acute care settings were utilized evenly among patients with BI improvement, and whether the incremental cost to gain the given BI improvement varied, depending on the functional status at admission.

Methods: The study administrative database contained 337,851 CVD patients across 1,050 hospitals from fiscal year (FY) 2006 to 2009. We identified a total of 61,191 CVD patients with available BI scores among 334 hospitals participating consecutively in the 4 study years. Patient and hospital characteristics, care process, BI score at admission and discharge, length of stay (LOS) and total charges (TC) were analyzed among three BI-at-admission categories. BI at admission was categorized into the following three groups: less than 59 dependent; 60 - 84 independent with assistance, and no less than 85 nearly completely independent. The effect of a one-point BI gain on LOS and TC was determined using mixed linear regression models.

Results: A total of 22,342 CVD patients across 327 hospitals were observed to have BI improvement at discharge. Among admitted patients, 59.5% were dependent and 25.6% were independent with assistance. Dependent status at admission was frequently associated with surgical procedures, ICU accommodation, ventilation and rehabilitation, whereas patients who were independent with assistance only had increased use of ICU and rehabilitation. Better functional status at admission reduced LOS and TC. One-point gain in the BI was associated with shorter LOS in patients with dependent functional status solely, and with more TC in those who were independent with assistance and nearly completely independent

Conclusions: We observed a variation in incremental cost required for BI improvement among three functional status groups at admission. Policy-makers should be aware of the variation in cost required for a given functional gain depending on the functional status category at admission, and plan the efficient healthcare policy for CVD patients for promoting functional convalescence.



J Neurol Res. 2011;1(3):96-104
doi: https://doi.org/10.4021/jnr42w