Andrea Gruneir1, Lauren E Griffith2, Kathryn Fisher2, Dilzayn Panjwani2, Sima Gandhi2, Li Sheng2, Chris Patterson2, Amiram Gafni2, Jenny Ploeg2, Maureen Markle-Reid2. 1. From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada. gruneir@ualberta.ca. 2. From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
Abstract
OBJECTIVE: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. METHODS: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. RESULTS: A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. CONCLUSIONS: Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
OBJECTIVE: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. METHODS: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. RESULTS: A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. CONCLUSIONS: Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
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