Rehabilitation in Geriatric Patients after Ischemic Stroke - A Comparison of 2 Organisational Systems in Germany Using Claims Data of a Statutory Health Insurance Fund

Due to historical aspects in some federal states in Germany rehabilitation of geriatric patients is organized in geriatric departments in hospitals ( 109 SGB V). In other states rehabilitation of these patients is mainly realized in geriatric rehabilitation facilities outside hospital care after approval by the health insurance ( 111 SGB V). Thus, it is of interest to compare both types of health care with respect to differences in population characteristics, resource utilization and outcome parameters (i.e., excess costs, rehospitalization, fracture risk and mortality) using a common geriatric indication, the ischemic stroke, as an example. Methods: Claims data of the AOK (Local Health Care Fund) from seven federal states in Germany were used. Insured persons with a documented hospital stay with discharge diagnosis cerebral infarction/stroke (ICD-10 I63, I64, below denoted by ischemic stroke) in 2007 (N=39887) were included and allocated to the respective form of rehabilitative health care via the OPS (German procedure classification for inpatient procedures) procedure 8-550 ( 109, N=1272) or via admission to a geriatric rehabilitation unit within 1 month after hospital discharge ( 111, N=2200). All direct costs were ascertained and presented with and without costs of long-term care. Excess costs were calculated as the difference of costs between the first year after insult and the costs in the previous year. Excess costs in the 2 types of care were compared using multivariate quantile regression analysis. Risk of hospitalization (due to ischemic stroke or fracture) and risk of death in a 1-year follow-up was analysed using multivariate cox regression. Results: Insured members treated according to health care type 109 were somewhat older (mean: 81 vs. 80 years of age), more frequently female (72 vs. 67%), more often receiving long-term care (27 vs. 19%) and had more often documented sequelae after insult (>=4 diseases 39 vs. 28%). No significant differences in excess costs between both types of care were observed (quantile regression: 25%-percentile-comparison: p=0.49 and 0.11; median-comparison: p=0.99 and 0.13; 75%-percentile-comparison: p=0.13 and 0.30, with and without costs of long-term care, respectively). Moreover, no significant differences were observed related to the outcomes rehospitalization due to ischemic stroke' (hazard ratio - HR [95% confidence interval - CI])=1.12 [0.85-1.48], p=0.43) and death (HR [95% CI]=1.03 [0.88-1.20], p=0.75) in the multivariate model (reference: health care type 111). Insured members in health care type 109 had a significant lower risk of rehospitalization due to fracture (HR [95% CI]=0.61 [0.40-0.93], p=0.02). Conclusion: According to health care type 109 and 111, geriatric patients differ in certain characteristics such as gender, statutory care and documented sequelae after insult. Except for the outcome fracture', no significant differences between both types of care have been observed in the selected outcomes. Primary studies with more differentiated data collection may focus on specific treatment and on aims and achievements of rehabilitation.