Improving post-stroke health outcomes: Can facilitated care help?

• Published in: Health policy (Amsterdam) Vol. 93; no. 2; pp. 180 - 187
• Main Authors: Kucukyazici, Beste, Verter, Vedat, Nadeau, Lyne, Mayo, Nancy E
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-12-2009; Elsevier
• Series: Health Policy
• Subjects: Acute services; Aged; Canada; Community care; Community Health Services; Databases as Topic; Discharged; Facilitated care; Female; Health administration; Health care; Health policy; Health status; Hospitalization; Hospitals; Humans; Illness; Internal Medicine; Long-Term Care - utilization; Male; Markov Chains; Markov modeling; Markovian processes; Middle Aged; Modelling; Mortality; Mortality rate; Outcome Assessment (Health Care); Post-discharge; Quebec; Quebec - epidemiology; Stroke; Stroke - mortality; Stroke Post-discharge Markov modeling Facilitated care Health policy; Stroke Rehabilitation; Strokes; Markov modeling; Facilitated care; Stroke; Health policy; Post-discharge
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2009.07.010

Abstract Objectives The objectives of this study were (1) identifying the patterns of post-stroke care, (2) determining the care-provider and patient characteristics associated with optimal management of post-stroke care and (3) estimating the potential influence of various facilitated care policies on outcomes. Methodology The 3946 subjects included in the study were admitted to one of Quebec's acute-care hospitals with confirmed diagnosis of stroke and subsequently discharged to their home. The records related to fee-for-service billings of this sample were obtained for the 3 months following discharge and used to define the care-provider path for each stroke survivor. These paths were analyzed and the potential impact of various facilitated care interventions was estimated via a Markov model. Results The rate of mortality for this sample was 3.2% during the first 3 months after discharge. For the patients who were re-hospitalized, however, the mortality rates were up to 10.3% depending on the care-provider visited prior to re-hospitalization. Our analyses indicate that by avoiding such critical sub-paths via facilitated care, it is possible to achieve improvements in health outcomes as well as cost. Discussion There is a window of opportunity for improving community-based post-stroke care. Facilitated care policies concerning planned visits upon discharge from hospital or following ER visits can improve the outcomes.