Trade-offs between effectiveness and efficiency in stroke rehabilitation.

Autor: Koh GC; Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. ephkohch@nus.edu.sg, Chen C, Cheong A, Choo TB, Pui CK, Phoon FN, Ming CK, Yeow TB, Petrella R, Thind A, Koh D, Seng CK
Jazyk: angličtina
Zdroj: International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2012 Dec; Vol. 7 (8), pp. 606-14. Date of Electronic Publication: 2011 Oct 06.
DOI: 10.1111/j.1747-4949.2011.00612.x
Abstrakt: Background: Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation.
Aims: To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency.
Methods: Using a retrospective cohort study design, we studied all stroke patients (n = 2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period.
Results: Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were • older age • race-ethnicity • caregiver availability • ischemic stroke • longer time to admission • dementia • admission Barthel Index score, and • length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≤70 years (β -4·7 (95% confidence interval -7·4 to -2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2-4·0) in effectiveness but a decrease of 0·04 (95% confidence interval -0·05 to -0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7-10·3) in effectiveness but a decrease of 0·82 (95% confidence interval -0·90 to -0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30-62 and length of stay was 37-41 days.
Conclusions: There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.
(© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)
Databáze: MEDLINE
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