Patient- and Hospital-Level Determinants of Rehabilitation for In-Patient Stroke Care: An Observation Analysis

Medicine (Baltimore). 2016 May;95(19):e3620. doi: 10.1097/MD.0000000000003620.

Abstract

During acute stroke care, rehabilitation usage may be influenced by patient- and hospital-related factors. We would like to identify patient- and hospital-level determinants of population-level inpatient rehabilitation usage associated with acute stroke care.From data obtained from the claim information from the National Health Insurance Administration (NHIA) in Taiwan (2009-2011), we enrolled 82,886 stroke patients with intracerebral hemorrhage and cerebral infarction from 207 hospitals. A generalized linear mixed model (GLMM) analyses with patient-level factors specified as random effects were conducted (for cross-level interactions).The rate of rehabilitation usage was 51% during acute stroke care. The hospital-related factors accounted for a significant amount of variability (intraclass correlation, 50%). Hospital type was the only significant hospital-level variable and can explain the large amount of variability (58%). Patients treated in smaller hospitals experienced few benefits of rehabilitation services, and those with surgery in a smaller hospital used fewer rehabilitation services. All patient-level variables were significant.With GLMM analyses, we identified the hospital type and its cross-level interaction, and explained a large portion of variability in rehabilitation for stroke patients in Taiwan.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Cerebral Hemorrhage / rehabilitation
  • Cerebral Infarction / rehabilitation
  • Female
  • Hospitals / statistics & numerical data*
  • Humans
  • Inpatients / statistics & numerical data*
  • Linear Models
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Stroke Rehabilitation / statistics & numerical data*
  • Taiwan