Healthcare Utilization After Stroke: A 1-Year Prospective Study

Abstract

Objectives: This study was undertaken to investigate the predictive value of disease-related factors, contextual factors, and functioning on the use of healthcare for 1 year after stroke.

Design: A prospective study.

Setting and participants: In total, 219 patients with stroke admitted to a hospital stroke unit were included.

Methods: Data were obtained through medical records, structured interviews, and assessments. Multivariable regression analyses were used to explore the association between the independent variables (stroke severity, comorbidity, age, sex, civil status, private financing, sense of coherence, cognitive function, walking ability, social everyday activities prestroke, and recent fall) and the use of inpatient or outpatient care 0 to 3, 3 to 6 and 6 to 12 months after stroke.

Results: Mean age of the participants was 70 years, 43% were women, and 71% experienced mild stroke severity. All participants received inpatient care at 0 to 3 months, about one-fifth used inpatient care at 3 to 6 or 6 to 12 months, and all received outpatient care all 3 time periods. Moderate-severe stroke (P < .001), a lower age (P = .002), and walking disability (P < .001) were associated with a higher use of inpatient care 0 to 3 months after stroke. Living alone (P = .025) and recent fall (P = .05) were associated with a higher use of inpatient care 3 to 6 months after stroke. None of the independent variables were associated with use of inpatient care 6 to 12 months. Moderate-severe stroke (0-3; 3-6 months: P < .001, 6-12 months: P = .004), a lower age (0-3 months: P = .002, 3-6 months: P = .001, 6-12 months: P = .006), and walking disability (P < .001) were associated with a higher use of outpatient care in all 3 time periods.

Conclusions and implications: Moderate-severe stroke, lower age, and walking disability are important predictors of healthcare utilization after stroke. The findings inform efforts to identify and support people with stroke who have the potential for high healthcare utilization in the year post stroke.

Keywords: Stroke; healthcare; prospective; utilization.