http://journals.lww.com/md-journal/Fulltext/2016/05100/Patient__and_Hospital_Level_Determinants_of.50.aspx
Medicine:
doi: 10.1097/MD.0000000000003620
Research Article: Observational Study
Chen, Tsung-Tai PhD; Chen, Chia-Pei RN, MS; Kuang, Shao-Hua MS; Wang, Vinchi MD, PhD
Section Editor(s): Gopichandran., Vijayaprasad
Author Information
From the Department of Public Health (TTC), School of
Medicine (VW), College of Medicine, Fu-Jen Catholic University, and
Neurological Center, Cardinal Tien Hospital, New Taipei City, Taiwan
(VW), Medical Quality Management Center, Nursing Department, Cardinal
Tien Hospital, and College of Nursing, National Taipei University of
Nursing and Health Sciences, Taipei, Taiwan (CPC), Medical Affairs
Office, Cardinal Tien Hospital (SHK).
Correspondence: Vinchi Wang, Neurological Center,
Cardinal Tien Hospital, 362, Zhongzheng Road, Xindian District, New
Taipei City 231, Taiwan (e-mail: vwneur@yahoo.com.tw).
Abbreviations: AIC = Akaike Information Criterion, CI =
cerebral infarction, ECM = Elixhauser Comorbidity Measures, GLMM =
generalized linear mixed model, HHI = Herfindahl–Hirschman Index, ICC =
intraclass correlation coefficient, ICH = intracranial hemorrhage, NHIA =
National Health Insurance Administration, PCV = proportional change in
variance.
This study was supported by grants from the Cardinal Tien Hospital (CTH-103-1-2B05) in Taiwan.
The authors have no conflicts of interest to disclose.
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Abstract
Abstract: During acute stroke care, rehabilitation
usage may be influenced by patient- and hospital-related factors. We
would like to identify patient- and hospital-level determinants of
population-level inpatient rehabilitation usage associated with acute
stroke care.
From data obtained from the claim information from the
National Health Insurance Administration (NHIA) in Taiwan (2009–2011),
we enrolled 82,886 stroke patients with intracerebral hemorrhage and
cerebral infarction from 207 hospitals. A generalized linear mixed model
(GLMM) analyses with patient-level factors specified as random effects
were conducted (for cross-level interactions).
The rate of rehabilitation usage was 51% during acute
stroke care. The hospital-related factors accounted for a significant
amount of variability (intraclass correlation, 50%). Hospital type was
the only significant hospital-level variable and can explain the large
amount of variability (58%). Patients treated in smaller hospitals
experienced few benefits of rehabilitation services, and those with
surgery in a smaller hospital used fewer rehabilitation services. All
patient-level variables were significant.
With GLMM analyses, we identified the hospital type
and its cross-level interaction, and explained a large portion of
variability in rehabilitation for stroke patients in Taiwan.
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