title: The impact of stroke on the cost and level of care in nursing homes: a retrospective population-based study.
abstract: OBJECTIVE
  To estimate the impact of incident stroke on nursing home (NH) costs and level of care.
  
  
  METHODS
  This retrospective population-based cohort study is part of a larger study that identified all Rochester, Minn, residents with a confirmed first stroke occurring between January 1, 1988, and December 31, 1989. One Rochester resident who had not had a stroke was matched to each person with stroke. Persons with and without stroke were followed up in provider-linked medical records and NH files from baseline (i.e., date of stroke) through December 31, 1994, for evidence of NH use. This study characterized the NH activity of those individuals with any NH activity after baseline (58 persons with major stroke, 36 persons with minor stroke, and 63 persons without stroke) as to NH case mix at first assessment, number of NH days, and per diem Medicaid reimbursement.
  
  
  RESULTS
  Characteristics at first NH assessment after baseline revealed that NH residents with major stroke were younger and more disabled and required more services than residents without stroke. Over the full period of follow-up, the mean number of NH days was similar for NH residents with major stroke and those without stroke, yet per diem Medicaid reimbursement was 11% higher for residents with major stroke compared with residents without stroke. Nursing home residents with minor stroke appeared similar to those without stroke with respect to time to admission, characteristics at first assessment, number of NH days, and per diem Medicaid reimbursement.
  
  
  CONCLUSIONS
  Lower incidence and severity of stroke may contribute to lower care needs and per diem cost, but no fewer NH days.
authors.affiliation: Pharmacia Corporation, Kalamazoo, Mich., USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Hass
authors.forename: J E
authors.initials: JE
authors.lastname: Ransom
authors.forename: R D
authors.initials: RD
authors.lastname: Brown
authors.forename: W M
authors.initials: WM
authors.lastname: O'Fallon
authors.forename: J P
authors.initials: JP
authors.lastname: Whisnant
authors.forename: C L
authors.initials: CL
authors.lastname: Leibson
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008484:Medicaid; D008910:Minnesota; D009735:Nursing Homes / Q000191:economics*; D012042:Registries; D012189:Retrospective Studies; D017678:Sex Distribution; D020521:Stroke / Q000191:economics*