Socioeconomic aspects of postacute care for patients with brain infarction in France.
BACKGROUND
In France, the socioeconomic aspects of stroke have never been addressed. Such analyses are essential for health authorities to justify the establishment of new stroke units when resources are low, provided it can be shown that stroke units are effective in reducing both the morbidity and mortality of stroke. Only 6 dedicated stroke services exist for 60 million inhabitants in France. Our aim was to study acute and postacute pathways and to determine the factors that influence destination after discharge, handicap evolution and costs.


METHODS
In a cohort of 494 consecutive patients with brain infarction, we collected information on medical and socioeconomic variables, handicap and its evolution using the modified Rankin scale and Mini-Mental Status score at the 10th day, 6th month and 18th-40th month. These data were recorded during the initial hospital stay, at the follow-up clinic visit and in a home interview done 18-40 months after discharge by research nurses. We used multiple logistic regression for analyses.


RESULTS
The most important factor for not returning home was having a Rankin score greater than 3 with an odds ratio of 41.7 (95% confidence interval 19.2-90.0; p = 0.001). Multivariate analysis showed that when the Rankin score was 0, 1 or 2, the main factors for not returning home were socioeconomic variables and serious medical disorders. When the Rankin score was 4 or 5, the main reason for not being sent for rehabilitation was medical status. After adjustment for the Rankin score, patients who returned home or were transferred to rehabilitation were quite similar regarding socioeconomic and medical variables. Other patients transferred to a geriatric ward, nursing home or new housing were more frequently living alone, 60 years of age or older, had less than 2 children, low level of education, dementia or cancer. Overall, the mean cost was 19,513 Euros over an 18-month period and was mainly driven by the level of the Rankin score (e.g. 10,530 vs. 34,809 Euros for Rankin scores of 0-1 and 4-5, respectively).


CONCLUSIONS
These data showed that not only handicap level but also socioeconomic variables are important in determining the destination of stroke patients after discharge. They may help health authorities to make decisions to establish new approaches to treat stroke. This study can also serve as a basis for future cost-effectiveness studies of new drugs being evaluated in therapeutic trials or of new management strategies of stroke patients.
Spieler
Jean-François
JF
Institut National de la Santé et de la Recherche Médicale (U537), Paris, France.
Lanoe
Jean-Louis
JL
Amarenco
Pierre
P
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000191:economics* / Q000451:nursing*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000191:economics; D012047:Rehabilitation Centers / Q000191:economics; D012307:Risk Factors; D012959:Socioeconomic Factors