Factors associated with prolonged hospital stay for acute stroke in Taiwan.

BACKGROUND AND PURPOSE Stroke is one of the causes of prolonged hospital stay (PHS) in Taiwan. This study aimed to examine the magnitude and associated factors for such prolonged stays. METHODS Patients admitted between 1997 and 2002 with the principal diagnosis of acute cerebrovascular diseases were identified from the claims data of a nationally representative cohort of 200,000 National Health Insurance enrollees. There were 2,358 subjects eligible for analysis. PHS was defined as length of stay > or = 23 days. Patient and hospital factors related to PHS were explored. RESULTS A total of 245 subjects (10.4%) had PHS, but they accounted for 38.9% of the total person-hospital days and 47.8% of the total in-hospital medical expenses. PHS was statistically associated to surgical operation, physical/ADL dependency, infections or aspiration pneumonia, speech/swallowing disorders, female, stroke types, increased number of comorbidities, and increased age. PHS was inversely related to in-hospital mortality. CONCLUSIONS An organized, multidisciplinary team approach should be initiated early after the onset of acute stroke to minimize functional disability, prevent complications and hence decrease the likelihood of PHS. Establishment of an integrated and affordable post-acute system should be a policy priority to effectively reduce unnecessary acute hospital use and to ensure a seamless stroke care.