Factors influencing rehabilitation costs for stroke inpatients in Shenzhen: a multicenter retrospective study

Stroke is a leading cause of death and disability among Chinese residents, imposing a significant economic burden. This study aimed to analyze the current status and influencing factors of inpatient rehabilitation costs for stroke in Shenzhen, providing evidence to help reduce costs for patients with stroke in rehabilitation centers.

This multicenter retrospective study used data primarily collected from patient's medical records. We included patients admitted to the rehabilitation departments of public and private hospitals in Shenzhen from January 1, 2019, to October 31, 2021, who met the diagnostic criteria for stroke. After data cleaning, we collected information on hospital demographics, diagnoses, functional impairments, length of stay, and hospitalization costs. Multiple linear regression analysis was used to create a path analysis model to assess the direct and indirect effects of various factors on total hospitalization and average daily expenditures.

The study included 2638 patients with stroke from 22 hospitals in Shenzhen, with 69.6% males and an average age of 59.2 years. Ischemic and hemorrhagic strokes accounted for 56% and 44% of the cases, respectively. The median total hospitalization costs were 27,306.64 Chinese Yuan (CNY) (4022.79 USD) for ischemic stroke and 32,188.25 CNY (4022.79 USD) for hemorrhagic stroke, while the average daily costs were 848.64 CNY (125.87 USD) and 828.23 CNY (125.87 USD), respectively. The median length of stay (LOS) was 30 days for patients with ischemic stroke and 41 days for patients with hemorrhagic stroke. Rehabilitation accounted for the highest cost category (64% and 68%, respectively). Path analysis revealed that LOS was the primary direct factor influencing total hospitalization costs, while hospital grades, functional impairment levels, disease stage, and age were indirect factors. For average daily costs, the primary direct influencing factor was hospital grades, with functional impairment levels, disease stage, and age as indirect factors.

Patients with stroke in Shenzhen face significant financial burden. The government should continuously promote the construction of a three-tiered rehabilitation system and hierarchical LOS management to provide systematic and sustainable medical services. Daily costs should be stratified based on functional impairment levels, disease stage, and age to guide the reform of precision bed-day medical insurance payments for stroke rehabilitation.

The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registration date: 22 June 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).