Article

Care pathways and healthcare management are not well described for
patients hospitalized for stroke. METHODS: Among the 51 million beneficiaries of
the French national health insurance general scheme
(77% of the French
population), patients hospitalized for a first stroke in 2012 and still alive six
months after discharge were included using data from the national health
insurance information system (Sniiram). Patient characteristics were described by
discharge destination-home or rehabilitation center (for < 3 months)-and were
followed during their first three months back home. RESULTS: A total of 61,055
patients had a first admission to a public or private hospital for stroke (mean
age; 72 years, 52% female), 13% died during their stay and 37% were admitted to a
stroke management unit. Overall, 40,981 patients were still alive at six months:
33% of them were admitted to a rehabilitation center (mean age: 73 years) and 54%
were discharged directly to their home (mean age 67 years). For each group, 45
and 62% had been previously admitted to a stroke unit. Patients discharged to
rehabilitation centers had more often comorbidities, 39% were highly physically
dependent and 44% were managed in specialized neurology centers. For patients
with a cerebral infarction who were directly discharged to their home 76%
received at least one antihypertensive drug, 96% an antithrombotic drug and 76% a
lipid-lowering drug during the following month. For those with a cerebral
hemorrhage, these frequencies were respectively 46, 33 and 28%. For those
admitted to a rehabilitation center, more than half had at least one visit with a
physiotherapist or a nurse, 15% a speech therapist, 10% a neurologist or a
cardiologist and 15% a psychiatrist during the following three months back home
(average numbers of visits for those with at least one visit: 23 for
physiotherapists and 100 for nurses). Patients who returned directly back home
had fewer physiotherapist (30%) or nurse (47%) visits but more medical
consultations. The 3-month re-hospitalization rate for patients who were
discharged directly to their home was 23% for those who had been admitted to a
stroke unit and 25% for the others. In rehabilitation centers, this rate was 10%
for patients who stayed < 3 months. CONCLUSIONS: These results illustrate the
value of administrative databases to study stroke management, care pathways and
ambulatory care. These data should be used to improve care pathways,
organization, discharge planning and treatments.
CI - Copyright (c) 2016 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS