Optimal Model Of Care Research Articles

Principles of organization of medical care for patients with heart failure in the system of cardiovascular risk management: focus on continuity of care and patient routing. Practical materials

The extent of the problem of heart failure determines the priority of the intention of developing and implementing an optimal model of medical care for this group of patients. The article describes the key components of the heart failure medical care (continuity, patient routing, educational activities) and provides examples of documents, protocols, checklists that can be used in real clinical practice by specialists in medical organizations in the regions of the Russian Federation.

Медична допомога дітям у навчальних закладах: стан, проблеми та перспективи розвитку

В статті проведено аналіз систем медичного забезпечення дітей шкільного віку, особливостей організації. Міжнародний досвід свідчить, що існують різні моделі медичного забезпечення дітей у навчальних закладах: відмінності щодо підпорядкування шкільної служби (структурам охорони здоров’я або освіти), фінансування, підготовки кадрів та найбільш — щодо профілактичної спрямованості: обсягу та терміну проведення профілактичних медичних оглядів. Всесвітня організація охорони здоров’я наголошує, що поки оптимальної моделі шкільної охорони здоров’я в світі не визначено. Загальними проблемами шкільної охорони здоров’я є недостатнє фінансування, нерівномірний доступ дітей до медичних послуг. Наведено стан медичного забезпечення школярів у країнах пострадянського простору, результати змін у галузі охорони здоров’я дітей, що стосувалися реформування системи санітарно-епідеміологічних закладів, модернізації їх функцій, створення нових вертикальних структур, функціями яких є розробка національних і регіональних програм щодо пропаганди здорового способу життя, медичної освіти та комунікаційна діяльність. Проаналізовано розвиток системи шкільної медицини в Україні з позиції «Концепції стандартів якості шкільних медичних послуг і компетенцій» Європейського союзу шкільної та університетської медицини. Окреслено перспективи шкільної медицини в Україні, а саме: потреба у розробці і запровадженні нової української моделі шкільної медицини, адаптованої до європейських стандартів, та інтегрування її у систему громадського здоров’я, що затверджено в Україні; оновлення нормативно-правової бази; розвиток кадрового потенціалу; формування нових професійних компетентностей медичних працівників шкільної медицини в Україні; посилення міжвідомчої взаємодії в питаннях допомоги збереження здоров’я дітям і підліткам, які навчаються.

Models of provider care in long-term care: A rapid scoping review.

IntroductionOne of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents.MethodsWe conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer.ResultsA total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory.ConclusionMany healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.

Background and Expectations for Reorganizing Mental Health Services for Children and Adolescents

Background: сhild psychiatry is essential for preventing adult mental diseases, due to the timely detection of a disease and the initiation of treatment. Thus, the choice of the optimal model of care and the corresponding transformation of the service are important. This work should be preceded by the study of current perceptions of the service and the prospects for its development among specialists and representatives of patients.The purpose: to study representatives’ expectations and fears related to the service, as well as to investigate the current needs of the professionals and their readiness for the service reform in Moscow.Material and methods: 657 district child psychiatrists and employees of clinical departments of children mental hospital in Moscow, and 361 consumers of the service filled in paper questionnaires on October 7–10, 2019.Results: neither the specialists nor the consumers have a general idea for the service development in Moscow. The professionals are more likely to consider their own field of work as a priority for development. The patient representatives expressed a wish for expanding service availability (including its territorial basis), while only 8% advocate the development of outpatient care as a priority. 49% of the specialists see a child as a main recipient of care, and 29% consider a family as a main recipient. 76% of the specialists found it difficult to answer the question about the existence of rules for interaction with a family. The experts consider the main request of a child as “condition stabilization” (85%), while the children themselves do not think in such categories. The myths about the service among the health workers and general population are similar, with the population expressing fears about being “registered” if they seek psychiatric help. At the same time, the loyalty of mental health specialists is comparable to the average in Moscow, primarily due to the high assessment of the staff.Conclusion: the study revealed a number of the related issues which are important to consider when reforming the service.

Use of evidence and technology to improve quality and eliminate low-value care

One-third of health care in the United States is wasted. Despite this recognition, solutions are sparse. The Optimal Care model combines evidence-based medicine, patient-centered technology, and outcomes reporting to transform health care.

Chronic Care, Dementia Care Management, and Financial Considerations

The needs of persons living with Alzheimer's disease and Alzheimer's disease–related dementia (AD/ADRD) are challenged by tremendous complexity impacting both care delivery and financing. Most persons living with dementia (PLWD) also suffer from other chronic medical or mental health conditions, which further burden quality of life and function. In addition to difficult treatment choices, optimal dementia care models likely involve people and services that are not typical pieces of the health care delivery system but are all critical partners—care partners, social workers, and community services, to name a few. More than 200 models of dementia care have demonstrated some efficacy. However, these successful interventions that might address much of the care needed by PLWD are uninsured in the United States, where insurance coverage has focused on acute care needs. This poses great difficulties for both care provision and care financing. In this article, we review these 3 key challenges: dementia care for those with chronic comorbid disease; care models that require people who are not typical providers in traditional care delivery systems; and the mandate to provide high-quality care that is currently not funded by usual health care insurance. We propose promising next steps that could substantially improve the lives of PLWD and the lives of their care partners, and highlight some of the many research questions that remain.

A New Era: The Growth of Video-Based Visits for Remote Management of Persons with Parkinson's Disease.

The COVID-19 pandemic forced the abrupt and rapid expansion of an alternative care model that embraces the use of video-based visits in the care of persons with Parkinson’s disease. Video-based visits not only eliminate the risk of infection but also reduce geography- and disability-related barriers to accessing specialist care. Research has established that they are feasible, acceptable to persons with Parkinson’s disease and patient-centered. In the Unites States, the relaxation of licensure requirements, adoption of reimbursement parity and investment in telemedicine infrastructure has enabled the rapid growth of video-based visits during the COVID-19 pandemic. Now, we must turn our attention to ensuring that progress made in expanding access to video-based care is not lost and expanded worldwide. More work is needed to identify the optimal video-based care model, establish best practices, and ensure equitable access to care.

An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care.

The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. We identified 2 themes: "Communication addressing the emotional and physical aspects of disease" and "Filling gaps in care"; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.

Tailored communication methods as key to implementation of evidence-based solutions in primary child health care.

BackgroundEvidence-based policies should underpin successful implementation of innovations within child health care. The EU-funded Models of Child Health Appraised project enabled research into effective methods to communicate research evidence. The objective of this study was to identify and categorize methods to communicate evidence-based research recommendations and means to tailor this to stakeholder audiences.MethodsWe conducted an online survey among national stakeholders in child health. Analysis of the most effective strategies to communicate research evidence and reach the target audience was carried out in order to ensure implementation of optimal child health care models at a national level.ResultsRepresentatives of stakeholders from 21 of the then 30 EU MS and EEA countries responded to the questionnaire. Three main approaches in defining the strategies for effective communication of research recommendations were observed, namely: dissemination of information, involvement of stakeholders and active attitude towards change expressed in actions. The target audience for communicating recommendations was divided into two layers: proximal, which includes those who are remaining in close contact with the child, and distal, which contains those who are institutionally responsible for high quality of child health services. They should be recipients of evidence-based results communicated by different formats, such as scientific, administrative, popular and personal.ConclusionsInfluential stakeholders impact the process of effective research dissemination and guide necessary actions to strengthen the process of effective communication of recommendations. Communication of evidence-based results should be targeted to each audience’s profile, both professional and non-professionals, by adjusting appropriate communication formats.

Primary care management of patients with pain complaints and the influence of physician training in mechanical diagnosis and therapy

Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits. The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT. This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19). The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints. Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care.

Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach

BackgroundAcute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. Lacking any prior evidence on optimizing outcomes for EGS patients, current implementation of ACS models has been idiosyncratic. We sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of ACS care for EGS patients.MethodsWe developed and implemented a national survey of hospital-level EGS structures and processes by surveying surgeons or chief medical officers regarding hospital-level structures and processes that directly or indirectly impacted EGS care delivery in 2015. These responses were then anonymously linked to 2015 data from the American Hospital Association (AHA) annual survey, Medicare Provider Analysis and Review claims (MedPAR), 17 State Inpatient Databases (SIDs) using AHA unique identifiers (AHAID). This allowed us to combine hospital-level data, as reported in our survey or to the AHA, to patient-level data in an effort to further examine the role of EGS structures and processes on EGS outcomes. We describe the multi-step, iterative process utilizing the Donabedian framework for quality measurement that serves as a foundation for later work in this project.ResultsHospitals that responded to the survey were primarily non-governmental and located in urban settings. A plurality of respondent hospitals had fewer than 100 inpatient beds. A minority of the hospitals had medical school affiliations.DiscussionOur results will enable us to develop a measure of preparedness for delivering EGS care in the US, provide guidance for regionalized care models for EGS care, tiering of ACS programs based on the robustness of their EGS structures and processes and the quality of their outcomes, and formulate triage guidelines based on patient risk factors and severity of EGS disease.ConclusionsOur work provides a template for team science applicable to research efforts combining primary data collection (i.e., that derived from our survey) with existing national data sources (i.e., SIDs and MedPAR).

Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life.

Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN. In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.

Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis.

Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear. To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures. Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914). One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26-17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07-242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87-17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other. Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear.

Holistic Management of Older Patients With Hip Fractures.

As the silver tsunami hits the world, older patients with hip fractures are expected to increase to 6.3 million by the year 2050, of which the majority will occur in Asia. The estimated global cost of hip fractures in the year 2050 is estimated to reach U.S. $130 billion. Hence, in addition to implementation of prevention strategies, it is important to develop an optimal model of care for older patients with hip fracture to minimize the huge medical and socioeconomic burden, especially in rapidly aging nations. This review summarizes the complications of hip fractures, importance of comprehensive geriatric assessment, and multidisciplinary rehabilitation, as well as predictors of rehabilitation outcome in older patients with hip fracture.

Transcatheter mitral valve repair for functional mitral regurgitation: Evaluating the evidence

ObjectivesTwo trials (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation Trial) were published in 2018 evaluating the effectiveness and safety of transcatheter repair for patients with heart failure with significant functional mitral regurgitation, which yielded different results. This article reviews the strength of the evidence, differences in trial designs, ethical and implementation implications, and delineates future research needs to help guide the appropriate dissemination of transcatheter repair for functional patients with mitral regurgitation. MethodsThe National Heart, Lung, and Blood Institute convened a workshop of interdisciplinary experts to address these objectives. ResultsTranscatheter repair of functional mitral regurgitation can provide significant benefits in terms of heart failure hospitalizations, survival, and quality of life when appropriate heart failure candidates with moderate to severe or severe mitral regurgitation while on optimal guideline-directed medical therapy can be identified. Key ingredients for success are preoperative evaluation and management and postoperative care by an interdisciplinary heart team. ConclusionsGiven the discordance observed between trials, ongoing innovation in patient management, and potential expansion of indications for use, the evidence base must be expanded to optimize appropriate implementation of this complex therapy. This will require more complete capture of outcome data in real-world settings for all eligible candidates whether or not they receive this therapy. Inevitably, the indications for use of this therapy will expand, as will the devices and therapeutic approaches for this population, necessitating the study of comparative effectiveness through randomized trials or observational studies. Moreover, given the substantial variations in care delivery, conducting implementation research to delineate characteristics of the optimal care model would be of benefit.

Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study.

Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models. We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15-17 years and 18-20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15-17 years and 18-20 years in the Ontario cohort. The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6-14.4) at age 15-17 years and 14.4 (95% CI 13.5-15.3) at age 18-20 years in Ontario, and 11.4 (95% CI 7.0-15.8) at age 15-17 years and 10.5 (95% CI 6.4-14.6) at age 18-20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94-1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91-1.17) of diabetes-related admissions across transition. Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.

Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey.

There is an increasing demand for trans and gender diverse (TGD) health services worldwide. Given the unique and diverse healthcare needs of the TGD community, best practice TGD health services should be community-led. We aimed to understand the healthcare needs of a broad group of TGD Australians, how health professionals could better support TGD people, and gain an understanding of TGD-related research priorities. An anonymous online survey received 928 eligible responses from TGD Australian adults. This paper focuses on three questions out of that survey that allowed for free-text responses. The data were qualitatively coded, and overarching themes were identified for each question. Better training for healthcare professionals and more accessible transgender healthcare were the most commonly reported healthcare needs of participants. Findings highlight a pressing need for better training for healthcare professionals in transgender healthcare. In order to meet the demand for TGD health services, more gender services are needed, and in time, mainstreaming health services in primary care will likely improve accessibility. Evaluation of training strategies and further research into optimal models of TGD care are needed; however, until further data is available, views of the TGD community should guide research priorities and the TGD health service delivery.

Ambulatory emergency oncology: A key tenet of future emergency oncology care.

Ambulatory emergency oncology The challenges of emergency oncology alongside its increasing financial burden have led to an interest in developing optimal care models for meeting patients' needs. Ambulatory care is recognised as a key tenet in ensuring the safety and sustainability of acute care services. Increased access to ambulatory care has successfully reduced ED utilisation and improved clinical outcomes in high-risk non-oncological populations. Individualised management of acute cancer presentations is a key challenge for emergency oncology services so that it can mirror routine cancer care. There are an increasing number of acute cancer presentations, such as low-risk febrile neutropenia and incidental pulmonary embolism, that can be risk assessed for care in an emergency ambulatory setting. Modelling of ambulatory emergency oncology services will be dependent on local service deliveries and pathways, but are key for providing high quality, personalised and sustainable emergency oncology care. These services will also be at the forefront of much needed emergency oncology to define the optimal management of ambulatory-sensitive presentations.

Rationale and design of a randomized pragmatic trial of patient-centered models of hepatitis C treatment for people who inject drugs: The HERO study

BackgroundAlthough people who inject drugs (PWID) having the highest incidence and prevalence of hepatitis C virus (HCV) in the US, HCV treatment is rarely provided to PWID due to assumptions about poor adherence and reinfection risk. As direct-acting antiviral agents (DAAs) have achieved sustained virologic response (SVR) rates of 95% or more, evidence-based strategies are urgently needed to demonstrate real-world effectiveness in marginalized patient populations such as PWID. The objectives of this study are: 1) to determine whether either of two patient-centered treatment models – patient navigation (PN) or modified directly observed therapy (mDOT) – results in more forward movement along the HCV care cascade including treatment initiation, adherence, and SVR; 2) using quantitative and qualitative methods, to understand factors associated with lack of treatment uptake, poor adherence (<80%), failure to achieve SVR, DAA resistance, and HCV reinfection. MethodsThe HERO study is a multi-site, pragmatic randomized clinical trial conducted in eight states where 754 HCV-infected PWID were randomly assigned to either PN or mDOT. ConclusionsThis study addresses an urgent need for timely and accurate information on optimal models of care to promote HCV treatment initiation, adherence, treatment completion and SVR among PWID, as well as rates and factors associated with reinfection and resistance after treatment. This clinical trial has the potential to provide valuable information on how to reduce the burden of the HCV epidemic in PWID.

Prognostic indicators of the lack of a great functional improvement and sustained disability among in-patients with cerebral stroke who were managed in a Comprehensive Stroke Unit

High-quality care may help reduce the severity of stroke consequences, but the optimal model of in-patient cerebral stroke care is not yet defi ned. The aim of the study was to determine the predictors of failing to achieve favorable functional outcome assessed with the Barthel index (BI) after treatment in the Comprehensive Stroke Unit (CSU). Patients with cerebral stroke, who were in 2010 to 2018 admitted to the Stroke Center — a multidisciplinary hospital unit that operates according to the CSU principles — were enrolled to the study. Patients’ data were prospectively entered into a special database and included baseline and fi nal assessments with neurological scales. If the BI total at discharge exceeded 60 or increased at least by 50 compared with baseline, the favorable outcome was considered achieved, otherwise — failed. Among 677 included in-patients, age 20 to 95 years, 271 (40.4 %) females, 80.8 % had an ischemic, and 19.2 % hemorrhagic cerebral stroke. The median NIHSS score at was 10. The onset to CSU hospitalization delay ranged from less 24 hours (17.5 % of the patients) to more than 180 days (17.2 % of the patients), and 59.7 % of the participants were admitted during the fi rst 30 days from the index stroke. In multivariate analysis, 7 indicators were strongly and independently linked with the risk for unfavourable functional outcome. The area under the operating characteristics curve (AUC = 0.93) indicates excellent consistency of the prediction model and the strong association of the predictors with the risk for a signifi cant need in help in ADLs. Independent predictors of functional insolvency can help better estimate the prognosis and optimize decision making on treatment strategy. Patient’s age, recurrent stroke, severity of the initial impairments and long delay to CSU admission has the most signifi cant infl uence on the risk for disability after discharge from CSU.