Improving post-stroke health outcomes: can facilitated care help?
OBJECTIVE
The objectives of this study were (1) identifying the patterns of post-stroke care, (2) determining the care-provider and patient characteristics associated with optimal management of post-stroke care and (3) estimating the potential influence of various facilitated care policies on outcomes.


METHODS
The 3946 subjects included in the study were admitted to one of Quebec's acute-care hospitals with confirmed diagnosis of stroke and subsequently discharged to their home. The records related to fee-for-service billings of this sample were obtained for the 3 months following discharge and used to define the care-provider path for each stroke survivor. These paths were analyzed and the potential impact of various facilitated care interventions was estimated via a Markov model.


RESULTS
The rate of mortality for this sample was 3.2% during the first 3 months after discharge. For the patients who were re-hospitalized, however, the mortality rates were up to 10.3% depending on the care-provider visited prior to re-hospitalization. Our analyses indicate that by avoiding such critical sub-paths via facilitated care, it is possible to achieve improvements in health outcomes as well as cost.


CONCLUSIONS
There is a window of opportunity for improving community-based post-stroke care. Facilitated care policies concerning planned visits upon discharge from hospital or following ER visits can improve the outcomes.
Kucukyazici
Beste
B
Desautels Faculty of Management, McGill University, 1001 Sherbrooke Street West, Montreal, Quebec, Canada H3A 1G5. beste.kucukyazici@mail.mcgill.ca
Verter
Vedat
V
Nadeau
Lyne
L
Mayo
Nancy E
NE
D000368:Aged; D003153:Community Health Services; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011792:Quebec / Q000453:epidemiology; D020521:Stroke / Q000401:mortality; D000071939:Stroke Rehabilitation