Factors Associated With Length of Stay for Patients With Stroke in Malaysia

Prediction of hospitalization time and independence level with functional outcomes for patients with acute stroke: a retrospective study

OBJECTIVES

The objective of this study was to develop predictive models for estimating the length of stay (LOS) with standardized clinical outcome measures (Functional Independence Measure, Trunk Impairment Scale, Postural Assessment Scale for Stroke Patients, Fugl Meyer Assessment Scale, and Functional Ambulation Category) during acute care setting.

METHODS

One hundred sixty-nine patients were included in the retrospective study. Predictors chosen for the LOS included scores of functional outcome measures at admission. We used Spearman's rank correlation coefficients to calculate correlations among clinical outcome measures and LOS, stepwise multiple regression analysis to develop a predictive model, and receiver operating characteristics curve to analyze the predictive value of explanatory factors obtained from the previous model for discharge Functional Independence Measure score.

RESULTS

The predictive equation explained 81% of the variance in LOS. The most important predictors were trunk impairment, motor function of the upper extremity, walking ability, and independence level at admission. The receiver operating characteristic curve was obtained with a cut-off score of 13 points for the Trunk Impairment Scale, 47 points for Fugl Meyer Assessment-Upper Extremity, and 2 points for Functional Ambulation Category, demonstrating the highest percentage of the accurately predicted ability of independence level at discharge.

DISCUSSION

The models presented in this study could help clinicians and researchers to predict the LOS and discharge independence level of clinical outcomes for patients with acute stroke enrolled in an acute care setting.

Direct Medical Cost of Stroke and the Cost-Effectiveness of Direct Oral Anticoagulants in Atrial Fibrillation-Related Stroke: A Cross-Sectional Study

BACKGROUND

Stroke has significant direct medical costs, and direct oral anticoagulants (DOACs) are better alternatives to warfarin for stroke prevention in atrial fibrillation (AF). This study aimed to determine the direct medical costs of stroke, with emphasis on AF stroke and the cost-effectiveness of DOACs among stroke patients in a tertiary hospital in Malaysia.

METHODS

This study utilised in-patient data from the case mix unit of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) between 2011 and 2018. Direct medical costs of stroke were determined using a top-down costing approach and factors associated with costs were identified. Incremental cost effectiveness ratio (ICER) was calculated to compare the cost-effectiveness between DOACs and warfarin.

RESULTS

The direct medical cost of stroke was MYR 11,669,414.83 (n = 3689). AF-related stroke cases had higher median cost of MYR 2839.73 (IQR 2269.79-3101.52). Regression analysis showed that stroke type (AF versus non-AF stroke) (p = 0.013), stroke severity (p = 0.010) and discharge status (p < 0.001) significantly influenced stroke costs. DOACs were cost-effective compared to warfarin with an ICER of MYR 19.25.

CONCLUSIONS

The direct medical cost of stroke is substantial, with AF-stroke having a higher median cost per stroke care. DOACs were cost effective in the treatment of AF-related stroke in UKMMC.