Abstract
Stroke rehabilitation focuses on alleviating post-stroke disability. Post-acute care (PAC) offers an intensive rehabilitative program as transitional care following acute stroke. A novel home-based PAC program has been initiated in Taiwan since 2019. Our study aimed to compare the current inpatient PAC model with a novel home-based PAC model in cost-effectiveness and functional recovery for stroke patients in Taiwan. One hundred ninety-seven stroke patients eligible for the PAC program were divided into two different health interventional groups. One received rehabilitation during hospitalization, and the other received rehabilitation by therapists at home. To evaluate the health economics, we assessed the total medical expenditure on rehabilitation using the health system of Taiwan national health insurance and performed cost-effectiveness analyses using improvements of daily activity in stroke patients based on the Barthel index (BI). Total rehabilitative duration and functional recovery were also documented. The total rehabilitative cost was cheaper in the home-based PAC group (p < 0.001), and the cost-effectiveness is USD 152.474 ± USD 164.661 in the inpatient group, and USD 48.184 ± USD 35.018 in the home group (p < 0.001). Lesser rehabilitative hours per 1-point increase of BI score was noted in the home-PAC group with similar improvements in daily activities, life quality and nutrition in both groups. Home-based PAC is more cost-effective than inpatient PAC for stroke rehabilitation.
Highlights
Stroke is a common cause of disability and morbidity associated with increased economic burden [1]
Patients transferred to ICU, p = 0.525) and duration from stroke onset to Post-acute care (PAC) initiation
There were no significant differences in comorbidities (Charlson comorbidity index and comorbid cardiovascular conditions) or healthcare utilization in the year before the stroke event
Summary
Stroke is a common cause of disability and morbidity associated with increased economic burden [1]. Complications of stroke include limb weakness, low physical fitness, sensory defects, dysphagia, aphasia, poor coordination, cognitive impairment, anxiety, and depression [3,4,5,6]. The American Heart Association/American Stroke Association recommends rehabilitation as a primary mechanism for functional recovery and independence in patients with acute stroke [7]. Because caring for patients with stroke-related disabilities exerts considerable physical, psychological, and economic burden on healthcare systems, caregivers, and societies in general [8], stroke rehabilitation is initiated in the acute stage. Post-acute care (PAC) is designed to maximize functional recovery
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