Impact of Initial Stroke Rehabilitation Placement on Functional Recovery and Cost-effectiveness

初始中风康复安置对功能恢复和成本效益的影响

• 批准号: 10172960
• 负责人: Heather A Hayes
• 金额: $ 13.64万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172960
• 关键词: Active Learning; Activities of Daily Living; Acute; Admission activity; Age; Algorithms; Beds; Caring; Client; Climate; Clinical; Cognitive; Comparative Effectiveness Research; Complex; Cost Effectiveness Analysis; Data; Decision Making; Exercise; Future; Goals; Guidelines; Health; Health Care Costs; Health Policy; Health Services Research; Healthcare; Home; Hospitals; Hour; Individual; Inpatients; Insurance; K-Series Research Career Programs; Knowledge; Length of Stay; Measures; Medicare; Outcome; Outcomes Research; Patient Care; Patient Recruitments; Patients; Physicians; Policy Research; Quality of life; Quality-Adjusted Life Years; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Activity; Research Personnel; Severities; Skilled Nursing Facilities; Stroke; Time; TimeLine; United States; Work; acute care; acute stroke; base; bed capacity; care costs; career; career development; comorbidity; cost; cost effective; cost effectiveness; disability; functional outcomes; functional status; health related quality of life; improved; indexing; inpatient service; markov model; meetings; mortality; post stroke; programs; readmission rates; rehabilitation science; rehabilitation service; rehabilitative care; sociodemographics; stroke event; stroke patient; stroke rehabilitation; stroke survivor; tool

PROJECT SUMMARY/ABSTRACT Stroke is a leading cause of long-term disability in the United States. A large portion of the cost of stroke care is rehabilitation. Providing optimal rehabilitation services aids in mitigating long-term disability for people after stroke. There are a lack of clinical guidelines and poor understanding of long-term outcomes after discharge from acute stroke care to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) for individuals post-stroke. Our current healthcare climate requires faster decision making and early discharge, and the results may be inappropriate discharge to an IRF or SNF, and thus not providing the patient with optimal outcomes. This project will assess client (e.g., stroke severity, co-morbidities, and sociodemographic) and non-client (e.g., bed availability and insurance) variables identified at the end of the acute hospital stay to determine which of these variables are associated with discharge to an IRF or SNF (Research Aim 1). This project will follow the clients to determine which of these client and non-client variables are associated with functional change—based on the AM-PAC Inpatient “6-Clicks” Basic Mobility, Daily Activity, and Applied Cognitive tools at short-term (after discharge from IRF or SNF) and long-term (6-months post-stroke; Research Aim 2). We will also determine cost- effective strategies of placement into an IRF, to a SNF, versus a tailored, based on the client and non-client variables identified in Aim 1 (Research Aim 3). We will use Markov modeling to predict related costs and quality- adjusted life years using the Health-Related Quality of Life in Stroke Patients. Understanding the outcomes within these similar post-acute care settings (IRF/SNF) for stroke is important in a rapidly evolving healthcare climate. This study is significant because it will provide data about what initial client and non-client variables predict long- term outcomes after discharge to an IRF or SNF and identify cost-effective strategies based on these variables. These research activities provide experiential learning in support of my career development objectives. These include increasing my knowledge and expertise in health services and policy research (Career Aim 1), comparative effectiveness and outcome research (Career Aim 2), and cost-effective analyses (Career Aim 3). This career development award will allow me to achieve my goal of becoming an independent stroke rehabilitation science investigator. The ultimate outcome will be improved health outcomes for individuals post- stroke, reduced disability, and reduced healthcare costs.

项目总结/文摘