Abstract

Objective

To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital.

Design

Retrospective cohort study.

Setting

One acute and one rehabilitation hospital in Japan.

Participants

Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years).

Main outcome measures

Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital.

Results

Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166–$72 606) vs $14 129 ($11 169–$19 459) in cerebral infarction; and vs $15 035 ($10 920–$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419–$39 911) vs $18 052 ($10 631–$24 384)], while those with severe disability spent $25 476 ($13 340–$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5–24) points, compared with a modest improvement in patients with mild (6, 2–14) or severe disability (0, 0–5).

Conclusions

The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.

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