Mary E Walsh1,2, Jan Sorensen3, Rose Galvin4, David Jp Williams5,6, Joseph A Harbison7,8, Sean Murphy5,9,10, Ronan Collins8,11, Dominick Jh McCabe12,13,14, Morgan Crowe15, N Frances Horgan1. 1. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland. 2. HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland. 3. Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland. 4. Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland. 5. School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland. 6. Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland. 7. Department of Medicine for the Elderly, St James's Hospital, Dublin, Ireland. 8. Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland. 9. Department of Medicine for the Older Person and Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland. 10. School of Medicine, University College Dublin, Dublin, Ireland. 11. Department of Age-related Healthcare, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Dublin, Ireland. 12. Department of Neurology, Vascular Neurology Research Foundation and Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Dublin, Ireland. 13. Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK. 14. Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland. 15. Department of Medicine for the Elderly, St Vincent's University Hospital, Dublin, Ireland.
Abstract
INTRODUCTION: Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community. PATIENTS AND METHODS: Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly calendars and post-discharge interviews. Cost of stroke was estimated for each participant from hospital admission for one year. The association of fall-status with overall cost was tested with multivariable linear regression analysis adjusting for pre-stroke function, stroke severity, age and living situation. RESULTS: A total of 109 stroke survivors with complete follow-up data (mean age = 68.5 years (SD = 13.5 years)) were included. Fifty-three participants (49%) fell following stroke, of whom 28 (26%) had recurrent falls. Estimated mean total healthcare cost was €20,244 (SD=€23,456). The experience of one fall and recurrent falls was independently associated with higher costs of care (p = 0.02 and p < 0.01, respectively). DISCUSSION: The observed relationship between falls and cost is likely to be underestimated as aids and adaptions, productivity losses, and nursing home care were not included. CONCLUSION: This study points at differences across fall-status in several healthcare costs categories, namely the index admission, secondary/tertiary care (including inpatient re-admissions) and allied healthcare. Future research could compare the cost-effectiveness of inpatient versus community-based fall-prevention after stroke. Further studies are also required to inform post-stroke bone-health management and fracture-risk reduction.
INTRODUCTION: Falls are common post-stroke events but their relationship with healthcare costs is unclear. The aim of this study was to examine the relationship between healthcare costs in the first year after stroke and falls among survivors discharged to the community. PATIENTS AND METHODS: Survivors of acute stroke with planned home discharges from five large hospitals in Ireland were recruited. Falls and healthcare utilisation data were recorded using inpatient records, monthly calendars and post-discharge interviews. Cost of stroke was estimated for each participant from hospital admission for one year. The association of fall-status with overall cost was tested with multivariable linear regression analysis adjusting for pre-stroke function, stroke severity, age and living situation. RESULTS: A total of 109 stroke survivors with complete follow-up data (mean age = 68.5 years (SD = 13.5 years)) were included. Fifty-three participants (49%) fell following stroke, of whom 28 (26%) had recurrent falls. Estimated mean total healthcare cost was €20,244 (SD=€23,456). The experience of one fall and recurrent falls was independently associated with higher costs of care (p = 0.02 and p < 0.01, respectively). DISCUSSION: The observed relationship between falls and cost is likely to be underestimated as aids and adaptions, productivity losses, and nursing home care were not included. CONCLUSION: This study points at differences across fall-status in several healthcare costs categories, namely the index admission, secondary/tertiary care (including inpatient re-admissions) and allied healthcare. Future research could compare the cost-effectiveness of inpatient versus community-based fall-prevention after stroke. Further studies are also required to inform post-stroke bone-health management and fracture-risk reduction.
Authors: H P Adams; P H Davis; E C Leira; K C Chang; B H Bendixen; W R Clarke; R F Woolson; M D Hansen Journal: Neurology Date: 1999-07-13 Impact factor: 9.910
Authors: Silvia M A A Evers; Jeroen N Struijs; André J H A Ament; Marianne L L van Genugten; J Hans C Jager; Geertrudis A M van den Bos Journal: Stroke Date: 2004-04-08 Impact factor: 7.914