腦中風病人急性後期復健照護連續性與照護結果及醫療費用之關係

Associations of postacute rehabilitation continuity with care outcomes and medical expenses among patients with stroke

目標：腦中風病人急性後期照護不足導致失能情形與醫療費用不斷增加，過去研究顯示，照護連續性可改善病人照護結果並降低醫療費用，然而對於急性後期復健病人之研究仍屬缺乏。本研究針對缺血性腦中風急性後期復健病人，探討其從急性醫院轉銜至急性後期照護院所的照護連續性對照護結果及醫療費用之影響。方法：使用衛生福利資料檔，以首次於急性期出院後30天內接受住院或門診復健照護之缺血性腦中風病人為研究對象。依其所住的急性醫院與急性後期復健院所間前一年度的轉銜集中度（referral concentration）計算照護連續性，分為無、低、高三組。利用多變項迴歸分析照護連續性與出院後90天內再住院及總醫療費用之相關性。結果：共納入10,445位病人，高急性後期復健照護連續性，與缺血性腦中風病人出院後90天內再住院勝算較低相關，但轉銜集中度與病人出院後90天內總醫療費用無關。結論：高轉銜集中度可降低缺血性腦中風病人90天再住院，未來政策應該鼓勵院所間建立緊密合作關係，以提升照護結果。

Objectives: Inadequate postacute care for patients with stroke increases both disability rates and medical expenses. Studies have suggested that continuity of care can improve patient outcomes and reduce medical expenses. However, research specifically focused on postacute rehabilitation for patients with stroke remains limited. In the current study, the effects of care continuity during the transition from acute hospitals to postacute rehabilitation facilities on 90-day readmission and on medical expenses were examined for patients with ischemic stroke. Methods: This study considered data from the Health and Welfare Data Science Center, Taiwan, for patients with ischemic stroke who received inpatient or outpatient rehabilitation within 30 days after discharge from the acute phase of treatment. Continuity of care was assessed on the basis of the referral concentration between acute hospitals and postacute rehabilitation facilities in the year preceding evaluation; the concentration was categorized as none, low, or high. Multivariate regression analysis was conducted to explore the association between continuity of care, 90-day readmission, and total medical expenses. Results: A total of 10,445 patients were included. The findings indicated that high continuity of postacute rehabilitation care was associated with reduced odds of 90-day readmission, but referral concentration was not associated with 90-day total medical expenses. Conclusions: A higher referral concentration was associated with reduced 90-day readmission for patients with ischemic stroke. Future policies should encourage closer collaboration between acute hospitals and postacute rehabilitation facilities to improve care outcomes.