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Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.

Publication ,  Journal Article
Tyagi, S; Koh, GC-H; Nan, L; Tan, KB; Hoenig, H; Matchar, DB; Yoong, J; Finkelstein, EA; Lee, KE; Venketasubramanian, N; Menon, E; Chan, KM ...
Published in: BMC Health Serv Res
November 22, 2018

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.

Duke Scholars

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Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

November 22, 2018

Volume

18

Issue

1

Start / End Page

881

Location

England

Related Subject Headings

  • Subacute Care
  • Stroke
  • Spouses
  • Prospective Studies
  • Primary Health Care
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
 

Citation

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Tyagi, S., Koh, G.-H., Nan, L., Tan, K. B., Hoenig, H., Matchar, D. B., … Tan, C. S. (2018). Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res, 18(1), 881. https://doi.org/10.1186/s12913-018-3696-3
Tyagi, Shilpa, Gerald Choon-Huat Koh, Luo Nan, Kelvin Bryan Tan, Helen Hoenig, David B. Matchar, Joanne Yoong, et al. “Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.BMC Health Serv Res 18, no. 1 (November 22, 2018): 881. https://doi.org/10.1186/s12913-018-3696-3.
Tyagi S, Koh GC-H, Nan L, Tan KB, Hoenig H, Matchar DB, et al. Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res. 2018 Nov 22;18(1):881.
Tyagi, Shilpa, et al. “Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.BMC Health Serv Res, vol. 18, no. 1, Nov. 2018, p. 881. Pubmed, doi:10.1186/s12913-018-3696-3.
Tyagi S, Koh GC-H, Nan L, Tan KB, Hoenig H, Matchar DB, Yoong J, Finkelstein EA, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res. 2018 Nov 22;18(1):881.
Journal cover image

Published In

BMC Health Serv Res

DOI

EISSN

1472-6963

Publication Date

November 22, 2018

Volume

18

Issue

1

Start / End Page

881

Location

England

Related Subject Headings

  • Subacute Care
  • Stroke
  • Spouses
  • Prospective Studies
  • Primary Health Care
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospitalization