UTILIZATION OF ACUTE-CARE SERVICES IN THE YEAR BEFORE AND AFTER FIRSTSTROKE - A POPULATION-BASED STUDY

There is a need for accurate population-based data on the utilization of medical resources after stroke. The present study used the Rocheste r Stroke Registry to identify all Rochester, Minnesota residents with confirmed first stroke (hospitalized and nonhospitalized) during the p eriod of 1987 to 1989 (n = 292). Events were categorized by type of st roke and assigned Rankin severity. Inpatient and outpatient acute care activity for the 12 months before and after stroke for each individua l were obtained from billing tapes provided by Mayo Clinic, Olmsted Me dical Group, and affiliated hospitals. These providers account for >95 % of acute care received by Rochester residents. The results showed th at despite high poststroke mortality, total charges in the year after stroke were 3.4 times those for the previous year. Although greater th an 50% of utilization in the year poststroke occurred within the first 30 days, mean monthly charges for acute care remained significantly a bove prestroke levels for up to 5 months after the event. Poststroke c harges per person-day of follow-up were significantly higher for indiv iduals who were hospitalized for the event, who had subarachnoid hemor rhage, whose stroke occurred after admission to the hospital for anoth er reason, and who died within 7 days. Significantly lower poststroke charges were evident for persons with mild cerebral infarctions and pe rsons whose stroke occurred in a nursing home. Neither prestroke utili zation, age category, nor sex were predictive of poststroke charges. T he unique population-based data presented here have important implicat ions for efforts toward stroke prevention, intervention, and cost cont ainment.