Outpatient Rehabilitation Utilization and Associated Factors among Stroke Survivors under the National Health Insurance System in Taiwan

Autor: Shih-Hau Fu, 傅士豪
Rok vydání: 2008
Druh dokumentu: 學位論文 ; thesis
Popis: 96
Background and Objectives: Stroke is the leading causes of death and disability worldwide. The utilization and accessibility of outpatient rehabilitation services were reported vary with age, race, region, and across-country. This study explored the incidence of and associated factors to the use of outpatient rehabilitation one year after stroke onset among stroke survivors from a representative cohort from Taiwan’s National Health Insurance (NHI) program. Methods: Patients admitted consecutively between 1 January 1997 and 31 December 2002 with the principal diagnoses of acute cerebrovascular accidents were identified from the claims data of a nationally representative cohort of 200,000 NHI enrollees. Use of outpatient rehabilitation services was defined as reimbursement claims for physical therapy (PT), occupational therapy (OT), speech therapy (ST) and combination of these therapies. Independent variables included patient and hospital characteristics that stroke patients possessed during acute hospitalization period. Proxy indicators to represent stroke severity were constructed. Univariate and multivariate analysis were performed to analyze the main predictors of outpatient rehabilitation utilization among stroke survivors. Results: In total, 1,999 ischemic and 397 hemorrhagic stroke subjects who survived from the acute hospitalization were included in this study. Outpatient rehabilitation use was 17.9% (357/1,999) in ischemic and 23.9% (95/397) in hemorrhage group. PT was used in 17.4% and 23.7%; OT 12.1% and 18.1%; ST 2.2% and 2.8% in ischemic and hemorrhage patients respectively. The utilization of outpatient rehabilitation services in both ischemic and hemorrhagic groups was equal regardless of genders or onset years, but was different in age groups. The ischemic group aged 75+ years had less chance to get outpatient rehabilitation services (p=0.015); similar trend was observed in the hemorrhagic group (p=0.062). It was noteworthy that the association remained significant even after multivariate adjustment in both ischemic (adjusted odds ratio〔AOR〕=0.60, P=0.004) and hemorrhagic groups (AOR=0.36, P=0.016). Stroke patients coded with physical/ADL dependency were more likely to utilize outpatient rehabilitation services compared to their counterparts (AOR=6.10, P
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