Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2019 Nov 21;19(1):871. doi: 10.1186/s12913-019-4713-x.
Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare.
We compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013-2014 (n = 553), and to one large university hospital in Norway in 2012-2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome.
Participants were similar in both cohorts: mean age 73 years, 40-44% female, 12-13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process.
Similar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.
有报道称，脑卒中患者在康复治疗方面存在机会不均等的问题。本研究旨在确定和比较在两个具有全民医保的国家中，与急性脑卒中住院治疗后转诊和入住康复医院（IRF）相关的患者和服务因素。
我们比较了 2013-2014 年澳大利亚 8 家急性公立医院连续收治的 553 例脑卒中患者队列和 2012-2013 年挪威一所大型大学医院收治的 723 例脑卒中患者队列。主要结局为：转诊至 IRF；如果转诊，是否入住 IRF。采用 logistic 回归模型确定和比较每个结局的相关因素。
两个队列的参与者基本情况相似：平均年龄 73 岁，40-44%为女性，12-13%为颅内出血，约 77%为轻度脑卒中（国立卫生研究院脑卒中量表评分<8）。急性住院期间接受的服务有所不同（澳大利亚 vs. 挪威）：卒中单元治疗 82% vs. 97%，物理治疗 93% vs. 79%，作业治疗 83% vs. 77%，言语治疗 78% vs. 13%。转诊至 IRF 的比例分别为：48%（澳大利亚）和 37%（挪威）；住院比例分别为：35%（澳大利亚）和 28%（挪威）。两国患者转诊的相关因素均为：中度严重脑卒中、在急性住院期间接受卒中单元治疗或联合健康评估、居住在社区以及独立的脑卒中前活动能力。两国的关联方向基本一致；然而，仅在挪威，年龄较小的患者更有可能被转诊和住院。转诊患者住院模型确定的相关因素较少，这表明在此阶段过程中，还有其他因素很重要。
尽管服务提供和获得率存在差异，但在这两个国家，急性脑卒中后转诊至康复医院的相关因素相似。假设不可能为所有脑卒中患者提供住院康复治疗，那么就需要了解选择候选患者的标准，以解决不必要的偏见。
