Rehabilitation Reduced Readmission and Mortality Risks in Patients With Stroke or Transient Ischemic Attack: A Population-based Study. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Chang, Ku-Chou; Hung, Jen-Wen; Lee, Hsuei-Chen; Yen, Chu-Ling; Wu, Ching-Yi; Yang, Chung-Lin; Huang, Yu-Ching; Lin, Pei-Li; Wang, Hui-Hsuan
• Is Part Of: Medical care. Volume 56:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: stroke rehabilitation -- mortality -- readmission; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000888
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: It remains unclear whether rehabilitation has an impact on reducing the long-term risk of mortality or readmission following stroke or transient ischemic attack (TIA). Objectives: To investigate the association between the dosage and continuation of rehabilitation and the risk of outcome events (OEs) after stroke or TIA. Research Design: A retrospective cohort study using Taiwan's National Health Insurance database. Subjects: In total, 4594 patients admitted with first-ever acute stroke or TIA were followed-up for 32 months. Measures: The occurrence of 3 OEs: (1) vascular readmissions/all-cause mortality [vascular event (VE)], (2) all-cause readmissions/mortality (OE1), and (3) all-cause mortality (OE2), in model 1: none, low-intensity, and high-intensity rehabilitation; and model 2: inpatient plus/or outpatient rehabilitation. Results: Comparing with patients without rehabilitation, in model 1, patients receiving low-intensity rehabilitation had a lower risk of VE [Hazard ratio (HR), 0.77; 95% CI, 0.68–0.87] and OE1 (HR, 0.77; CI, 0.71–0.84), but not OE2 (HR, 0.91; CI, 0.77–1.07). Patients receiving high-intensity rehabilitation had lower risks of all VE (HR, 0.68; CI, 0.58–0.79), OE1 (HR, 0.79; CI, 0.71–0.88), and OE2 (HR, 0.56; CI, 0.44–0.71). In model 2, patients receiving inpatient plus outpatient rehabilitation had a lowest risk of VE (HR, 0.55; CI, 0.47–0.65), OE1 (HR, 0.65; CI, 0.58–0.72), and OE2 (HR, 0.45; CI, 0.35–0.59). Sensitivity analysis with TIA excluded rendered the similar trend. Subgroup analyses found that the positive effect was not demonstrated in hemorrhagic stroke patients. Conclusions: Rehabilitation use was associated with reduction of readmissions/mortality risks following stroke or TIA. The optimal intensity and duration of rehabilitation and the discrepancy shown in hemorrhagic stroke need further clarification. Abstract : Supplemental Digital Content is available in the text.