title: Patient- and Hospital-Level Determinants of Rehabilitation for In-Patient Stroke Care: An Observation Analysis.
abstract: During acute stroke care, rehabilitation usage may be influenced by patient- and hospital-related factors. We would like to identify patient- and hospital-level determinants of population-level inpatient rehabilitation usage associated with acute stroke care.From data obtained from the claim information from the National Health Insurance Administration (NHIA) in Taiwan (2009-2011), we enrolled 82,886 stroke patients with intracerebral hemorrhage and cerebral infarction from 207 hospitals. A generalized linear mixed model (GLMM) analyses with patient-level factors specified as random effects were conducted (for cross-level interactions).The rate of rehabilitation usage was 51% during acute stroke care. The hospital-related factors accounted for a significant amount of variability (intraclass correlation, 50%). Hospital type was the only significant hospital-level variable and can explain the large amount of variability (58%). Patients treated in smaller hospitals experienced few benefits of rehabilitation services, and those with surgery in a smaller hospital used fewer rehabilitation services. All patient-level variables were significant.With GLMM analyses, we identified the hospital type and its cross-level interaction, and explained a large portion of variability in rehabilitation for stroke patients in Taiwan.
authors.affiliation: From the Department of Public Health (TTC), School of Medicine (VW), College of Medicine, Fu-Jen Catholic University, and Neurological Center, Cardinal Tien Hospital, New Taipei City, Taiwan (VW), Medical Quality Management Center, Nursing Department, Cardinal Tien Hospital, and College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (CPC), Medical Affairs Office, Cardinal Tien Hospital (SHK).
authors.forename: Tsung-Tai
authors.initials: TT
authors.lastname: Chen
authors.forename: Chia-Pei
authors.initials: CP
authors.lastname: Chen
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Kuang
authors.forename: Vinchi
authors.initials: V
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000534:rehabilitation; D002544:Cerebral Infarction / Q000534:rehabilitation; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D000071939:Stroke Rehabilitation / Q000706:statistics & numerical data*; D013624:Taiwan