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Title: Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors
Authors: Tyagi S. 
Koh G.C.-H. 
Nan L. 
Tan K.B.
Hoenig H.
Matchar D.B. 
Yoong J. 
Finkelstein E.A. 
Lee K.E.
Venketasubramanian N.
Menon E. 
Chan K.M.
De Silva D.A.
Yap P.
Tan B.Y.
Chew E. 
Young S.H.
Ng Y.S.
Tu T.M.
Ang Y.H.
Kong K.H.
Singh R.
Merchant R.A. 
Chang H.M. 
Yeo T.T.
Ning C.
Cheong A. 
Ng Y.L.
Tan C.S. 
Keywords: adult
cerebrovascular accident
disabled person
factual database
general practice
health care cost
middle aged
outpatient department
patient attitude
primary health care
prospective study
statistics and numerical data
subacute care
Ambulatory Care Facilities
Databases, Factual
Disabled Persons
Facilities and Services Utilization
Family Practice
Health Expenditures
Middle Aged
Patient Acceptance of Health Care
Primary Health Care
Prospective Studies
Subacute Care
Issue Date: 2018
Citation: Tyagi S., Koh G.C.-H., Nan L., Tan K.B., Hoenig H., Matchar D.B., Yoong J., Finkelstein E.A., Lee K.E., Venketasubramanian N., Menon E., Chan K.M., De Silva D.A., Yap P., Tan B.Y., Chew E., Young S.H., Ng Y.S., Tu T.M., Ang Y.H., Kong K.H., Singh R., Merchant R.A., Chang H.M., Yeo T.T., Ning C., Cheong A., Ng Y.L., Tan C.S. (2018). Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC health services research 18 (1) : 881. ScholarBank@NUS Repository.
Abstract: BACKGROUND: It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS: Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS: Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p?=?0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p?=?0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p?=?0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p?=?0.032) subgroups respectively, compared to first quarter. CONCLUSION: Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.
Source Title: BMC health services research
ISSN: 1472-6963
DOI: 10.1186/s12913-018-3696-3
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