Costs In Stroke Patients Research Articles

Health Interventions May Have Divergent Impacts on Health and Economic Equity: A Case Study of the Community-Based Hypertension Improvement Project in Ghana.

Improving health and economic equity are key objectives in priority setting, particularly in low-income and middle-income countries. This study aims to assess the distributional impacts of the Community-based Hypertension Improvement Project (ComHIP) on health and economic outcomes across wealth quintiles in Ghana. We developed a decision analytical model to simulate a 30million cohort of Ghanaians aged 15-49years. The study specified health outcomes as the prevention of stroke cases and averting deaths among those with hypertension. Furthermore, we explored economic impacts, including savings in out-of-pocket costs for stroke patients and government spending. Financial risk protection against catastrophic and impoverishing health expenditures was also examined. We assessed these outcomes across wealth quintiles, and the corresponding concentration indexes (CIXs) were determined. It was estimated that ComHIP could prevent 1450 stroke cases and 564 related deaths annually. Health benefits were observed to be more significant among the wealthier quintiles (CIX 0.217), mainly attributed to a higher occurrence of hypertension within these groups. ComHIP was also projected to result in an annual saving of USD 49,885 in individuals' out-of-pocket costs (CIX 0.262) and USD 37,578 in government spending (CIX 0.146). These savings correspond to the prevention of 335 catastrophic health expenditure cases (CIX -0.239) and 11 impoverishing health expenditure cases (CIX -0.600). While ComHIP provides greater health benefits to wealthier groups, it offers substantial financial risk protection for the less wealthy. This study highlights the importance of considering equity in both health and financial risk when making priority-setting decisions.

Does cognitive decline/dementia increase Delirium risk after stroke?

Delirium is a common contributor to mortality and hospital costs in stroke patients. Different observational studies have showed inconsistent results regarding the association between cognitive decline/dementia and delirium after acute stroke. Therefore, we performed this meta-analysis with the aim of determining whether cognitive decline/dementia is related to the risk of delirium after acute stroke. We systematically searched PubMed, Embase, Google Scholar, and Web of Science for relevant studies from inception to September 2020. We calculated the pooled odds ratio (OR) with 95% confidence interval (CI) by using fixed or random effects models based on heterogeneity measured by the I2 index. The association between cognitive decline/dementia and post-stroke delirium was examined in 13 studies with 3183 participants. After pooled analysis, we found that cognitive decline/dementia was significantly associated with susceptibility to delirium in post-stroke patients (OR=3.70, 95%CI: 2.90-4.71, P < 0.001). Subgroup analysis suggested that cognitive decline/dementia was associated with an increased risk of delirium in Caucasians (OR=3.73, 95%CI: 2.73-5.11, P < 0.001), non-Caucasians (OR=3.65, 95%CI: 2.50-5.33, P < 0.001), samples with <200 subjects (OR=3.70, 95%CI: 2.17-6.31, P < 0.001), samples with ≥200 subjects (OR=3.70, 95%CI: 2.82-4.85, P < 0.001), studies published in 1990-2009 (OR=3.17, 95%CI: 1.48-6.77, P=0.003), and studies published in 2010-2020 (OR=3.76, 95%CI: 2.92-4.86, P < 0.001). We identified an association between cognitive decline/dementia and the risk of developing delirium. Cognitive decline/dementia may be a promising predictor for delirium in post-stroke patients.

An equity evaluation in stroke inpatients in regard to medical costs in China: a nationwide study

BackgroundStroke has always been a severe disease and imposed heavy financial burden on the health system. Equity in patients in regard to healthcare utilization and medical costs are recognized as a significant factor influencing medical quality and health system responsiveness. The aim of this study is to understand the equity in stroke patients concerning medical costs and healthcare utilization, as well as identify potential factors contributing to geographic variation in stroke patients’ healthcare utilization and costs.MethodsCovering 31 provinces in mainland China, our main data were a 5% random sample of stroke claims from Urban Employees Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) from 2013 to 2016. The Theil index was employed to evaluate the equity in stroke patients in regard to healthcare utilization and medical costs, and the random-effect panel model was used to explore the impact of province-level factors (health resource factors, enabling factors, and economic factors) on medical costs and health care utilization.ResultsStroke patients’ healthcare utilization and medical costs showed significant differences both within and between regions. The UEBMI scheme had an overall lower Theil index value than the URBMI scheme. The intra-region Theil index value was higher than the inter-region Theil index, with the Theil index highest within eastern China, China’s richest and most developed region. Health resource factors and enabling factors (represented by reimbursement rate and education attainment years) were identified significantly associated with medical costs (P < 0.05), but have no impact on average length of stay.ConclusionsChina’s fragmented urban health insurance schemes require further reform to ensure better equity in healthcare utilization and medical costs for stroke patients. Improving education attainment, offering equal access to healthcare, allocating health resources reasonably and balancing health services prices in different regions also count.

Abstract WP385: Delirium Significantly Contributes to Longer Hospitalization and Higher Post-Discharge Costs for Stroke Patients: An Analysis of Nationwide Data

Background: Healthcare costs related to delirium in the elderly and in the post-operative patient populations exceed $150 billion a year. Stroke patients are at a higher risk of developing delirium, which can significantly increase their healthcare costs. Incremental hospitalization and post-discharge costs associated with delirium have not been described in stroke patients. Methods: We analyzed Nationwide Readmission Data from 2010 - 2015 and identified adult (≥18) ischemic and hemorrhagic stroke patients. In-hospital delirium was identified using a validated algorithm. Patients who died during index hospitalization were excluded. Costs for index hospitalization and readmissions were determined using cost to charge ratios, and inflation adjusted to 2015 USD. We used generalized linear models to compare costs between delirious and non-delirious patients adjusting for demographics, comorbidities, illness severity, treatment intensity, in-hospital complications, and surgical procedures. Results: A total of 2,853,175 stroke discharges were included among whom 7.1% were documented to havein-hospital delirium on index admission. Delirious patients had a longer mean length of stay (12.01 vs 7.38 days), and higher 30-day readmission rates (16.7% vs 12.2%). At index admission, delirious patients had 9.9% higher adjusted costs of hospitalization as compared to non-delirious patients. For all admissions (including readmissions), delirious stroke patients had 12.3% higher adjusted costs of hospitalization, which translates into an additional $10,544.2 (2015) per hospitalization. (Figure) Conclusion: Our analyses highlight the potential cost savings in stroke care associated with prevention, recognition, early mitigation and effective management of delirium. Even though delirium prevalence may be underestimated in administrative data, these results indicate potential annual nationwide cost savings of more than $350 million for stroke care.

Impact of instrumental analysis of stiff knee gait on treatment appropriateness and associated costs in stroke patients

BackgroundStiff Knee Gait (SKG) in stroke patients is typically treated by the inhibition of the rectus femoris (RF) with botulinum toxin (BoNT) after clinical evaluation, obtaining an average pooled recovery in knee flexion (KF) of 7 degrees. PurposeOur hypothesis is that this limited recovery after BoNT could depend on the inadequacy in the selection of patients to be treated. The aim of this study was to assess the percentage of inappropriate treatments (PIT) that can be avoided when instrumental gait analysis (GA) is used, and to estimate the associated cost savings. MethodsWe retrospectively analyzed GA data from chronic stroke patients with SKG and clinically assessed knee extensors spasticity referred to our laboratory over a five-year period. Gait kinematics and dynamic electromyography data were used. Patients were considered unsuitable for RF inhibition when: their SKG was determined by inadequate ankle push-off (APO) rather than by a brake from knee extensors, based on a previously published algorithm using gait kinematics (PITKIN); when RF was not active during KF (PITEMG); and when a proximal braking mechanism was found, if this was not due to RF activity (PITGA). Results160 patients, age 20–87 years, gait speed 9–77%height/s, KF peak -4–44 degrees, were included. Of these, in 119 cases poor APO was the main cause of SKG, thus leading to PITKIN = 74%. In 48 out of 107 non-obese subjects, RF spasticity was not involved in SKG, resulting in PITEMG = 45%. Finally, patients with a braking activity as the main cause and concurrent RF activity were 20/107 = 19%, resulting in PITGA = 81% SignificanceWhen treating SKG, proper use of GA can reduce the percentage of inappropriate treatments by BoNT at the RF up to 81%. Savings are in the order of €100k/year when considering centers treating 100 or more patients/year.

The effects of infection on severe stroke patients in the neurological intensive care unit in China

ABSTRACTObjective: To study the effects of infection on severe stroke patients in the neurological intensive care unit and to find the related risk factors for mortality of severe stroke patients.Methods: We conducted a retrospective study including 343 patients with ischaemic or haemorrhagic stroke and staying for more than 2 patient-days in the neurological intensive care unit at Beijing Chaoyang Hospital from January 2011 to December 2015 to analyse the infection features of patients with severe stroke in the neurological intensive care unit. All analyses were conducted using SPSS 18.0.Results: The mortality rate, hospital staying time and hospital costs between infected and uninfected stroke patients were higher in the infected patients than in the uninfected patients, P < 0.05, and except for the hospital staying time, the mortality rate and hospital costs were both significantly higher in the infected patients. Respiratory tract infection was the most common infection type at all time periods, P < 0.05. However, urinary tract infection increased at 72 h after stroke compared with infection within 72 h after stroke. Blood sugar level, mean arterial pressure, scores of APACHE II, history of stroke, history of heart diseases, infections and respiratory tract infection were significantly different in dead patients compared with the alive patients, P < 0.05.Conclusion: Infection can significantly influence the mortality rate and hospital costs of stroke patients, and is an independent risk factor for mortality of stroke patients.

The influence of race on SLP utilisation and costs among persons with aphasia

ABSTRACTBackground: Recent evidence suggests racial disparities exist in post-stroke conditions such as aphasia, yet the underlying cause of such disparities is unclear. Disparities in rehabilitation service utilisation have been previously proposed as a contributor to racial disparities in post-stroke outcomes.Aim: To examine racial differences in speech–language pathology (SLP) service utilisation and costs among persons with aphasia being treated in acute care hospitals in North Carolina.Methods & Procedures: The North Carolina Healthcare Cost and Utilization Project data from 2011 to 2012 were analysed to examine SLP service utilisation and costs for stroke patients with aphasia. Analyses included length of stay (LOS) and charges/costs of SLP services. Generalised linear models were constructed to determine the impact of demographic characteristics, stroke severity, residence, and hospital fixed effects (variability of hospital management practices) on SLP utilisation and costs.Outcomes & Results: Approximately 5% more Blacks with aphasia were seen for SLP services than Whites with aphasia. LOSs were 2.1 days longer in acute care at 17% greater cost. Generalised linear models showed that Blacks with aphasia were seen for approximately 0.416 more visits than Whites after controlling for demographic characteristics, stroke/illness severity and residence and 0.25 more visits after controlling for hospital fixed effects. The slight increase in visits occurred at a cost of $57 when controlling for demographic characteristics, $63 when controlling for stroke/illness severity, $50 when controlling for residence, and $23 when controlling for hospital fixed effects.Conclusions: Blacks with aphasia utilise more SLP services during longer LOSs and with greater costs when compared to Whites with aphasia.

Risk of Malnutrition Is an Independent Predictor of Mortality, Length of Hospital Stay, and Hospitalization Costs in Stroke Patients

Malnutrition is associated with poor outcomes after stroke. Nutrition screening tools (NSTs) are used to identify patients at risk of malnutrition, but so far no NST has been validated for use with patients who have had a stroke. This study aimed to determine the ability of the Malnutrition Universal Screening Tool (MUST) to predict poor outcomes in stroke patients, including mortality, cumulative length of hospital stay (LOS), and hospitalization costs. Patients were recruited from consecutive admissions at 2 hyperacute stroke units in London and were screened for risk of malnutrition (low, medium, and high) according to MUST. Six-month outcomes were obtained for each patient through a national database. Of 543 recruited patients, 51% were males, the mean age was 75 years, and 87% had an ischemic stroke. Results showed a highly significant increase in mortality with increasing risk of malnutrition (P < .001). This association remained significant after adjusting for age, severity of stroke, and a range of stroke risk factors (P < .001). For those patients who survived, the LOS and hospitalization costs increased with increasing risk of malnutrition (P < .001 and P = .049, respectively). This association remained significant in the adjusted model (P < .001 and P = .001, respectively). Risk of malnutrition is an independent predictor of mortality, LOS, and hospitalization costs at 6 months post stroke. Research is needed to determine if nutritional support for medium- or high-risk patients results in better outcomes. Routine screening of stroke patients for risk of malnutrition is recommended.

Population-Based Study of Acute- and Long-Term Care Costs after Stroke in Patients with AF

New treatments for atrial fibrillation patients have been shown to be effective at reducing subsequent vascular event recurrence. However, there are few data on stroke costs in atrial fibrillation patients to allow the cost-effectiveness of these treatments to be assessed. Using data from a population-based study, we assessed the acute and long-term costs of stroke in atrial fibrillation patients. Health-care costs one-year before and five-years after stroke were obtained from a large population-based study (Oxford Vascular study). Costs were assessed for the three-months poststroke (acute period) and annually thereafter (postacute period). Annual postacute costs were compared with annual baseline costs. Based on patients' living arrangements, costs of institutionalization after the event were included. A total of 191 strokes occurred in 153 patients with known prior atrial fibrillation. Mean health-care costs after stroke were £10 413 (standard deviation 15 105) in the acute phase, with annual postacute health-care costs nonsignificantly smaller than those incurred before the event (£2400 vs. £3356, respectively; P = 0·198). However, for the 136 strokes surviving past the 90-day acute period, costs were nonsignificantly higher than those incurred in the year before the event (£3370 vs. £2566, respectively; P = 0·333). After stroke, 25 (13%) patients were newly admitted into long-term warden, nursing, or residential care, resulting in annual costs of £6880 (standard deviation 15 600) averaged across the 136 stroke cases surviving past the acute period. Although annual post acute phase hospital and primary health-care costs in stroke patients with prior atrial fibrillation were not significantly different to those incurred before the stroke, long-term nursing/residential care costs were substantial.

Predicting the cost of hospital stay for stroke patients: the use of diagnosis related groups

In order to provide tailor-made care, governments are considering the implementation of output-pricing based on hospital case-mix measures, such as diagnosis related groups (DRG). The question is whether the current DRG classification system can provide a satisfactory prediction of the variance of costs in stroke patients and if not, in what way other variables may enhance this prediction. In this study, data from 731 stroke patients hospitalized at University Hospital Maastricht during 1996–1998 are used in the cost analysis. The DRG classification for this group uses information—in addition to the DRG classification operation or no operation—on the patient's age combined with discharge status. The results of regression analysis show that using DRGs, the variance explained in the costs amounts to 34%. Adding other variables to the DRGs, the variance explained increases to about 61%. Additional factors highly correlating with inpatient costs are the level of functioning after stroke, comorbidity, complications, and ‘days of stay for non-medical reasons’. Costs decreased for stroke patients discharged during the latter part of the years studied, and if stroke patients happened to die during their hospital stay. The results do suggest that future implementation of output-pricing based on the DRG case-mix measures is feasible for stroke patients only if it is enhanced with information on complications and the level of functioning.

Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke

Objective: To determine the effectiveness of a new reflex cough test, using nebulized tartaric acid, in the evaluation of the laryngeal cough reflex and the development of aspiration pneumonia. Study Design: In this two-phase study, the cough test assessed the cough reflex in 161 stroke subjects. Phase 1 was a double-blinded prospective study of 40 subjects scheduled to have both modified barium swallow and the reflex cough test. Phase 1 subjects with an abnormal cough test showed an increased pneumonia incidence, and therefore, phase 2 was not blinded. In phase 2, 121 subjects were evaluated using the cough test; 38 received a modified barium swallow. Test results were compared using the Fisher exact test. Results: A total of 131 subjects from both phases had a normal reflex cough test; none developed pneumonia ( p < .01). Thirty subjects from both phases had abnormal reflex cough test results; 5 developed pneumonia. Modified barium swallow findings did not reliably indicate the risk for developing pneumonia. Specificity of a normal reflex cough test was 100%. Conclusion: The reflex cough test reliably evaluated the laryngeal cough reflex and the associated risk of developing aspiration pneumonia in stroke patients. Testing the laryngeal cough reflex may significantly reduce morbidity, mortality, and costs in stroke patients.