Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 May;82(5):424-427. doi: 10.1097/JCMA.0000000000000076.
Taiwan's NHI Administration proposed a nationwide postacute care-cerebral vascular disease (PAC-CVD) program, which transfers stroke patients at postacute phase in medical centers to community hospitals. Its aim is mainly to prevent a prolonged stay in medical centers, which usually results in higher medical costs. The present study evaluated the 3-months functional outcomes of stroke patients receiving PAC-CVD.
We retrogradely retrieved patients' data from Stroke Registry of a Northern medical center. Patients admitted between January 2014 and March 2018 were screened. We included patients receiving PAC-CVD and age/sex/stroke severity/functional status-matched acute stroke patients (regular rehabilitation group). Baseline clinical characteristics and 3-months functional outcomes were analyzed. We defined 3-months mRS 0 to 2 as better, 3 to 4 as same, and 5 to 6 as worse functional recovery.
One-hundred-and-seventy-three patients receiving PAC-CVD and 173 matched controls (68.2 ± 14.0-years-old, 68.5% ± 11.22% men) were recruited. All patients were with mRS 3 to 4 at discharge from our medical center. The distributions of 3-months functional recovery in two groups were as follows: better/same/worse 3-months functional outcomes, PAC-CVD = 40.4%/57.8%/1.8%; controls (regular rehabilitation) = 33.9%/50.3%/5.8%. Multivariate analyses adjusted for age, sex, NIHSS, and cardiovascular risk factors were performed to evaluate whether PAC-CVD predicted better or poor functional outcomes. The results showed that compared with controls, PAC-CVD group had similar frequency of better functional recovery (odds ratio [OR] = 0.97, 95% CI = 0.54-1.74, p = 0.924) but less frequency of worse functional outcomes (OR = 0.08, 95% CI = 0.008-0.84, p = 0.035).
About one-third of patients with mRS 3 to 4 recovered well in 3-months after stroke in both PAC-CVD and regular rehabilitation groups. Our results showed that PAC-CVD program can significantly decrease functional decline after acute stroke.
台湾健保署提出了一项全国性的急性后期照护-脑血管疾病（PAC-CVD）计划，将医疗中心的急性后期阶段的中风患者转移到社区医院。其主要目的是防止在医疗中心的长期滞留，这通常会导致更高的医疗费用。本研究评估了接受 PAC-CVD 的中风患者的 3 个月功能结局。
我们从北部医学中心的中风登记处回顾性检索患者数据。筛选 2014 年 1 月至 2018 年 3 月期间入院的患者。纳入接受 PAC-CVD 治疗且年龄/性别/中风严重程度/功能状态与急性中风患者相匹配的患者（常规康复组）。分析基线临床特征和 3 个月的功能结局。我们将 3 个月 mRS 0 到 2 定义为较好，3 到 4 定义为相同，5 到 6 定义为较差的功能恢复。
共纳入 173 名接受 PAC-CVD 的患者和 173 名匹配的对照组患者（68.2±14.0 岁，68.5%±11.22%为男性）。所有患者在出院时的 mRS 为 3 到 4。两组 3 个月功能恢复的分布如下：PAC-CVD 组更好/相同/较差的 3 个月功能结局为 40.4%/57.8%/1.8%；对照组（常规康复）为 33.9%/50.3%/5.8%。为评估 PAC-CVD 是否预测更好或较差的功能结局，我们对年龄、性别、NIHSS 和心血管危险因素进行了多变量分析。结果表明，与对照组相比，PAC-CVD 组较好的功能恢复频率相似（优势比[OR] = 0.97，95%CI = 0.54-1.74，p = 0.924），但较差的功能恢复频率较低（OR = 0.08，95%CI = 0.008-0.84，p = 0.035）。
在 PAC-CVD 和常规康复组中，约三分之一的 mRS 3 到 4 的中风患者在中风后 3 个月内恢复良好。我们的结果表明，PAC-CVD 计划可以显著降低急性中风后的功能下降。
