Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors.
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.
['Tyagi|Shilpa|S|', 'Koh|Gerald Choon-Huat|GC|', 'Nan|Luo|L|', 'Tan|Kelvin Bryan|KB|', 'Hoenig|Helen|H|', 'Matchar|David B|DB|', 'Yoong|Joanne|J|', 'Finkelstein|Eric A|EA|', 'Lee|Kim En|KE|', 'Venketasubramanian|N|N|', 'Menon|Edward|E|', 'Chan|Kin Ming|KM|', 'De Silva|Deidre Anne|DA|', 'Yap|Philip|P|', 'Tan|Boon Yeow|BY|', 'Chew|Effie|E|', 'Young|Sherry H|SH|', 'Ng|Yee Sien|YS|', 'Tu|Tian Ming|TM|', 'Ang|Yan Hoon|YH|', 'Kong|Keng Hee|KH|', 'Singh|Rajinder|R|', 'Merchant|Reshma A|RA|', 'Chang|Hui Meng|HM|', 'Yeo|Tseng Tsai|TT|', 'Ning|Chou|C|', 'Cheong|Angela|A|', 'Ng|Yu Li|YL|', 'Tan|Chuen Seng|CS|']
D000328:Adult D000368:Aged D000554:Ambulatory Care Facilities D017028:Caregivers D016208:Databases, Factual D006233:Disabled Persons D000078336:Facilities and Services Utilization D005194:Family Practice D005260:Female D005102:Health Expenditures D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D010342:Patient Acceptance of Health Care D011320:Primary Health Care D011446:Prospective Studies D018454:Spouses D020521:Stroke D019467:Subacute Care
Caregivers Stroke Hospitalization Health services Healthcare costs