title: Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan.
abstract: OBJECTIVE
  To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One acute and one rehabilitation hospital in Japan.
  
  
  METHODS
  Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years).
  
  
  METHODS
  Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital.
  
  
  RESULTS
  Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5).
  
  
  CONCLUSIONS
  The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Murata
authors.affiliation: Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Sadamasa
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.affiliation: Department of Neurosurgery, Kurashiki Rehabilitation Hospital, Okayama, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Asari
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawakami
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D007564:Japan; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000191:economics; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000191:economics*
keywords: healthcare costs; hospital care; rehabilitation/long-term care; stroke