Utilization of acute care services in the year before and after first stroke: A population-based study

There is a need for accurate population-based data on the utilization of medical resources after stroke. The present study used the Rochester Stroke Registry to identify all Rochester, Minnesota residents with confirmed first stroke (hospitalized and nonhospitalized) during the period of 1987 to 1989 (n=292). Events were categorized by type of stroke and assigned Rankin severity. Inpatient and outpatient acute care activity for the 12 months before and after stroke for each individual were obtained from billing tapes provided by Mayo Clinic, Olmstead Medical Group, and affiliated hospitals. These providers account for >95% of acute care received by Rochester residents. The results showed that despite high poststroke mortality, total charges in the year after stroke were 3.4 times those for the previous year. Although greater than 50% of utilization in the year poststroke occurred within the first 30 days, mean monthly charges for acute care remained significantly above prestroke levels for up to 5 months after the event. Poststroke charges per person-day of follow-up were significantly higher for individuals who were hospitalized for the event, who had subarachnoid hemorrhage, whose stroke occurred after admission to the hospital for another reason, and who died within 7 days. Significantly lower poststroke charges were evident for persons with mild cerebral infarctions and persons whose stroke occurred in a nursing home. Neither prestroke utilization, age category, nor sex were predictive of poststroke charges. The unique population-based data presented here have important implications for efforts toward stroke prevention, intervention, and cost containment.