脑卒中后医疗资源利用情况：一项为期 1 年的前瞻性研究。

Healthcare Utilization After Stroke: A 1-Year Prospective Study.

机构信息

Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Rehabilitation, Odense University Hospital, Odense, Denmark; The Health Research Center, UCL University College, Odense, Denmark.

Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA.

出版信息

J Am Med Dir Assoc. 2020 Nov;21(11):1684-1688. doi: 10.1016/j.jamda.2020.04.036. Epub 2020 Jul 12.

DOI:10.1016/j.jamda.2020.04.036

PMID:32669239

Abstract

OBJECTIVES

This study was undertaken to investigate the predictive value of disease-related factors, contextual factors, and functioning on the use of healthcare for 1 year after stroke.

DESIGN

A prospective study.

SETTING AND PARTICIPANTS

In total, 219 patients with stroke admitted to a hospital stroke unit were included.

METHODS

Data were obtained through medical records, structured interviews, and assessments. Multivariable regression analyses were used to explore the association between the independent variables (stroke severity, comorbidity, age, sex, civil status, private financing, sense of coherence, cognitive function, walking ability, social everyday activities prestroke, and recent fall) and the use of inpatient or outpatient care 0 to 3, 3 to 6 and 6 to 12 months after stroke.

RESULTS

Mean age of the participants was 70 years, 43% were women, and 71% experienced mild stroke severity. All participants received inpatient care at 0 to 3 months, about one-fifth used inpatient care at 3 to 6 or 6 to 12 months, and all received outpatient care all 3 time periods. Moderate-severe stroke (P < .001), a lower age (P = .002), and walking disability (P < .001) were associated with a higher use of inpatient care 0 to 3 months after stroke. Living alone (P = .025) and recent fall (P = .05) were associated with a higher use of inpatient care 3 to 6 months after stroke. None of the independent variables were associated with use of inpatient care 6 to 12 months. Moderate-severe stroke (0-3; 3-6 months: P < .001, 6-12 months: P = .004), a lower age (0-3 months: P = .002, 3-6 months: P = .001, 6-12 months: P = .006), and walking disability (P < .001) were associated with a higher use of outpatient care in all 3 time periods.

CONCLUSIONS AND IMPLICATIONS

Moderate-severe stroke, lower age, and walking disability are important predictors of healthcare utilization after stroke. The findings inform efforts to identify and support people with stroke who have the potential for high healthcare utilization in the year post stroke.

摘要

目的

本研究旨在探讨疾病相关因素、背景因素和功能对中风后 1 年医疗保健使用的预测价值。

设计

前瞻性研究。

地点和参与者

共纳入 219 名因中风住院的患者。

方法

通过病历、结构化访谈和评估获得数据。多变量回归分析用于探讨独立变量（中风严重程度、合并症、年龄、性别、婚姻状况、私人融资、应对能力、认知功能、中风前行走能力、社会日常活动和最近跌倒）与中风后 0-3、3-6 和 6-12 个月住院或门诊护理使用之间的关系。

结果

参与者的平均年龄为 70 岁，43%为女性，71%为轻度中风严重程度。所有患者在 0-3 个月内均接受住院治疗，约五分之一的患者在 3-6 个月或 6-12 个月内接受住院治疗，所有患者在所有 3 个时间段内均接受门诊治疗。中度至重度中风（P<0.001）、年龄较低（P=0.002）和行走障碍（P<0.001）与中风后 0-3 个月内更高的住院护理使用率相关。独居（P=0.025）和最近跌倒（P=0.05）与中风后 3-6 个月内更高的住院护理使用率相关。独立变量均与 6-12 个月的住院护理使用率无关。中度至重度中风（0-3 个月；3-6 个月：P<0.001，6-12 个月：P=0.004）、年龄较低（0-3 个月：P=0.002，3-6 个月：P=0.001，6-12 个月：P=0.006）和行走障碍（P<0.001）与所有 3 个时间段的门诊护理使用率较高相关。