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

Area of Science:

• Neurology
• Rehabilitation Medicine
• Health Services Research

Background:

• Limited research exists on stroke inpatients post-acute care (PAC).
• Propensity score matching (PSM) is infrequently used in natural experimental designs for stroke rehabilitation studies.
• Understanding the longitudinal impact of medical referral systems on functional status is crucial.

Purpose of the Study:

• To assess the impact of a medical referral system on stroke patients.
• To examine the longitudinal effects of this system on functional status using a natural experimental design and PSM.
• To evaluate the effectiveness of intensive, function-oriented PAC interventions.

Main Methods:

• Coupled a natural experimental design with propensity score matching (PSM).
• Analyzed stroke patients undergoing a hospital-based, 12-week to 1-year rehabilitative PAC intervention.
• Compared functional outcomes between intra-hospital and inter-hospital transfer groups.

Main Results:

• The average PAC duration was shorter in the intra-hospital transfer group (31.52 days) versus the inter-hospital transfer group (37.1 days).
• Intra-hospital transfer was associated with better functional outcomes.
• The training effect was more pronounced in patients with moderate (MRS=3) and moderately severe (MRS=4) disabilities compared to slight disabilities (MRS=2).

Conclusions:

• Intensive post-stroke rehabilitative care, especially when delivered via a per-diem payment model, is effective in improving functional status.
• Developing a vertically integrated medical system requires strengthening local hospitals with PAC wards, facilitating inter-hospital transfers, and ensuring adequate intensive PAC days.