Zorowitz Richard D, Chen Er, Tong Kuo Bianchini, Laouri Marianne
The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Top Stroke Rehabil. 2009 Sep-Oct;16(5):309-20. doi: 10.1310/tsr1605-309.
To examine mortality, costs, and rehabilitation use in patients with stroke and stroke-related hemiparesis during a 4-year period following stroke onset.
This study was a retrospective, longitudinal claims analysis. Patients newly diagnosed with stroke and discharged from the hospital were identified from a 5% random sample of Medicare beneficiaries. Mortality, total Medicare costs, use of rehabilitation, and associated costs in stroke survivors with or without hemiparesis were the main outcome measures.
Out of 4,604 newly diagnosed stroke patients, 1,166 developed hemiparesis. The 4-year mortality rate was significantly higher in the hemiparesis cohort than the nonhemiparesis cohort (55.2% vs. 47.5%; p < .01). The average Medicare cost per patient over the 4-year period was $77,143 for the hemiparesis cohort and $53,319 for the nonhemiparesis cohort (p < .01). A significantly higher proportion of patients in the hemiparesis cohort received rehabilitation than in the nonhemiparesis cohort (84% vs. 36% in Year 1, 30% vs. 10% in Year 2, 21% vs. 9% in Year 3, 16% vs. 7% in Year 4). Among patients who received rehabilitation, costs were significantly higher for the hemiparesis cohort ($17,680) than for the nonhemiparesis cohort ($7,841) in the fi rst year. While most rehabilitation costs for the hemiparesis cohort were incurred in the hospital inpatient setting in the fi rst year, the cost burden shifted to skilled nursing facilities and home health agencies in the following 3 years.
Hemiparesis following stroke onset contributes to a higher mortality rate and higher Medicare costs in both the short and long term.
研究卒中发病后4年期间，卒中及卒中相关性偏瘫患者的死亡率、费用及康复治疗的使用情况。
本研究为回顾性纵向索赔分析。从医疗保险受益人的5%随机样本中确定新诊断为卒中并出院的患者。有或无偏瘫的卒中幸存者的死亡率、医疗保险总费用、康复治疗的使用情况及相关费用是主要观察指标。
在4604例新诊断的卒中患者中，1166例出现偏瘫。偏瘫队列的4年死亡率显著高于非偏瘫队列（55.2%对47.5%；p<0.01）。4年期间，偏瘫队列每位患者的平均医疗保险费用为77143美元，非偏瘫队列为53319美元（p<0.01）。偏瘫队列接受康复治疗的患者比例显著高于非偏瘫队列（第1年为84%对36%，第2年为30%对10%，第3年为21%对9%，第4年为16%对7%）。在接受康复治疗的患者中，偏瘫队列第1年的费用（17680美元）显著高于非偏瘫队列（7841美元）。虽然偏瘫队列的大部分康复费用在第1年产生于医院住院环境，但在接下来的3年中，费用负担转移到了专业护理机构和家庭健康机构。
卒中发病后的偏瘫在短期和长期内均导致较高的死亡率和医疗保险费用。
