title: Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.
abstract: BACKGROUND
  Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care.
  
  
  OBJECTIVE
  The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings.
  
  
  METHODS
  Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants.
  
  
  RESULTS
  The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98).
  
  
  CONCLUSIONS
  Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.
authors.affiliation: Health Promotion Board, Singapore. sanjiv@alumni.nus.edu.sg
authors.forename: S K
authors.initials: SK
authors.lastname: Saxena
authors.forename: T P
authors.initials: TP
authors.lastname: Ng
authors.forename: D
authors.initials: D
authors.lastname: Yong
authors.forename: N P
authors.initials: NP
authors.lastname: Fong
authors.forename: K
authors.initials: K
authors.lastname: Gerald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004180:Direct Service Costs / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000191:economics* / Q000706:statistics & numerical data; D012846:Singapore; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics* / Q000451:nursing; D000071939:Stroke Rehabilitation