Post-Discharge Care Experience Among Stroke Patients Under The National Health Insurance Program In Taiwan: Do Health Professional And Their Relatives Have Better Experiences?

• Main Authors: Jack Sung, 宋建龍
• Other Authors: Yiing-Jenq Chou
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/drg5tr

碩士 === 國立陽明大學 === 公共衛生研究所 === 106 === Background Health care system transformation for optimal continuum of care is a top priority. Revolving door phenomenon and the “cracks” between acute care and long-term care systems expose a major deficiency in conventional health care system. Several developed countries have embraced an emerging concept of post-acute care in the late 20th century. However, their examples suggest that without a better understanding of patient’s post-discharge care experiences and its influencing factors, it would be difficult to obtain more precise assessment of accountability across providers and more proper incentive design of payment policies which are fundamental to health care system transformation. Many believe that patients and caregivers’ medical knowledge may help to establish their confidence in self-care management, influence preferences of and access to quality care, and physician-patient communication patterns, which may have critically shape people’s post-discharge care experience. But the empirical evidences supporting this proposition is relatively limited. Objectives Assuming health professionals and their relatives are more privileged and better informed about health and health care matters, we aimed to explore if there is a difference in post-discharge care experience between general stroke patients and patients who are health professionals or their relatives. Methods This study was a pooled cross-sectional study. Each eligible stroke patient was followed for 1 year after discharge. Patients were classified into two groups: health professionals (including their relatives) and non-health professionals using National Health Insurance (NHI) medical personnel registry and NHI enrollment files. A total of 55,510 new stroke patients were identified in the NHI claims data during the year 2015. Of them, 727 were health professional or their relatives. Length of days between discharge and first use of rehabilitation, utilization of inpatient and outpatient rehabilitation within 1 month, 3 months, 6 months, and 1 year after discharge, and 30-day readmission were accsessed. Age, gender, social economic status, comorbidities (the Charlson Co-morbidity Index [CCI]), and severity (the Stroke Severity Index [SSI]) were adjusted for in the model. Survival analysis was also applied. Results Patients who are health professional or their relatives had a shorter length of days between discharge and first use of any rehabilitation (median = 11 days vs 51 days). Their 30-day readmission rate after discharge was rather similar (14.86% vs 15.08%) compared to general stroke patient. After adjusting for patient’s demographics, socioeconomic status and severity, patients who are health professional and their relatives were significantly more likely to receive rehabilitation more timely. Conclusion The findings suggest that health professional patients who are presumably more knowledgeable and confidence about health and health care matters such as care transition and provider-patient communication have more timely post-acute care such as rehabilitation services.