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Open AccessArticle

Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status

1
Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital, Pingtung 90059, Taiwan
2
Department of Internal Medicine, St. Joseph Hospital, Kaohsiung 80760, Taiwan
3
Division of Neurology, Department of internal medicine, Yuan’s General Hospital, Kaohsiung 80249, Taiwan
4
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
5
School of Public Health, Taipei Medical University, Taipei 11031, Taiwan
6
Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei 11031, Taiwan
7
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
8
Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
9
Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
10
Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(8), 1233; https://doi.org/10.3390/jcm8081233
Received: 2 July 2019 / Revised: 15 August 2019 / Accepted: 15 August 2019 / Published: 16 August 2019
(This article belongs to the Special Issue Clinical Medicine for Healthcare and Sustainability)
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Abstract

Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study coupled a natural experimental design with PSM to assess the impact of a medical referral system in stroke patients and to examine the longitudinal effects of the system on functional status. The intervention was a hospital-based, function oriented, 12-week to 1-year rehabilitative PAC intervention for patients with cerebrovascular diseases. The average duration of PAC in the intra-hospital transfer group (31.52 days) was significantly shorter than that in the inter-hospital transfer group (37.1 days) (p < 0.001). The intra-hospital transfer group also had better functional outcomes. The training effect was larger in patients with moderate disability (Modified Rankin Scale, MRS = 3) and moderately severe disability (MRS = 4) compared to patients with slight disability (MRS = 2). Intensive post-stroke rehabilitative care delivered by per-diem payment is effective in terms of improving functional status. To construct a vertically integrated medical system, strengthening the qualified local hospitals with PAC wards, accelerating the inter-hospital transfer, and offering sufficient intensive rehabilitative PAC days are the most essential requirements. View Full-Text
Keywords: stroke; post-acute care; medical referral system; propensity score matching stroke; post-acute care; medical referral system; propensity score matching
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MDPI and ACS Style

Wang, C.-Y.; Hsien, H.-H.; Hung, K.-W.; Lin, H.-F.; Chiou, H.-Y.; Yeh, S.-C.J.; Yeh, Y.-J.; Shi, H.-Y. Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status. J. Clin. Med. 2019, 8, 1233.

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