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      Influencing factors of hospitalization costs for intensive rehabilitation in patients with post-stroke disorder of consciousness

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          Abstract

          Objective

          In China, patients requiring intensive rehabilitation often face a gap between acute treatment and sub-acute rehabilitation. This study evaluates the composition and determinants of post-acute hospitalization costs in stroke patients with disorders of consciousness (DoC).

          Methods

          Data from 133 stroke patients with DoC who underwent inpatient rehabilitation at a tertiary hospital from 2015 to 2020 were collected, including demographic characteristics, clinical features, and hospitalization costs. Descriptive statistical analysis and univariate analysis were performed, followed by path analysis and Bootstrap mediation tests to explore factors influencing hospitalization costs.

          Results

          The median hospitalization costs were $56,860.80. Rehabilitation costs accounted for the largest proportion of total hospitalization costs (36.55%). Direct factors influencing total costs included payment method, admission to the intensive care unit (ICU), pulmonary infection, and length of stay (LOS) ( p < 0.05). The effect sizes ranked in descending order were LOS, ICU experience, payment method, and pulmonary infection. Bootstrap mediation tests revealed significant mediation effects ( p < 0.05) of payment method, occupation, patient origin, hypertension, ICU experience, and death on total costs, indicating that these factors indirectly influenced costs by affecting LOS.

          Conclusion

          Greater attention should be given to meeting the rehabilitation needs of patients by expanding resources for intensive rehabilitation and ensuring continuous rehabilitation services. Comprehensive and effective measures should be implemented to address cost-influencing factors early, without compromising the quality of care.

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          Most cited references39

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          Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.

          Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed.
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            European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness

            Patients with acquired brain injury and acute or prolonged disorders of consciousness (DoC) are challenging. Evidence to support diagnostic decisions on coma and other DoC is limited but accumulating. This guideline provides the state-of-the-art evidence regarding the diagnosis of DoC, summarizing data from bedside examination techniques, functional neuroimaging and electroencephalography (EEG).
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              Economic burden of stroke: a systematic review on post-stroke care

              Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps.
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                Author and article information

                Contributors
                Role: Role:
                Role: Role: Role:
                Role: Role: Role: Role:
                Role: Role:
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                URI : https://loop.frontiersin.org/people/2933607/overviewRole: Role: Role: Role:
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                03 March 2025
                2025
                : 13
                : 1552148
                Affiliations
                [1] 1School of Healthcare Management, Tsinghua University , Beijing, China
                [2] 2School of Public Policy and Management, Tsinghua University , Beijing, China
                [3] 3Institute for Hospital Management, Tsinghua University , Shenzhen, China
                [4] 4Administrative Office, Shenzhen Longcheng Hospital , Shenzhen, China
                [5] 5General Management Department, Shenzhen Dapeng New District Medical and Health Group , Shenzhen, China
                Author notes

                Edited by: Giorgio Scivoletto, Santa Lucia Foundation (IRCCS), Italy

                Reviewed by: Alessandro Sodero, Careggi University Hospital, Italy

                Eric Christensen, Harvey L. Neiman Health Policy Institute, United States

                *Correspondence: Shilan Tang, tsl20@ 123456tinghua.org.cn
                Article
                10.3389/fpubh.2025.1552148
                11911356
                40098794
                cd0bb076-2c83-42b9-a340-c2b493617d2d
                Copyright © 2025 Yu, Huang, Yang, Wang, Ren and Tang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 02 January 2025
                : 18 February 2025
                Page count
                Figures: 1, Tables: 5, Equations: 0, References: 39, Pages: 9, Words: 5617
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by The National Social Science Fund of China (No. 17ZDA121). China National Health Development Research Center (Study on Total Health Insurance Package Payment and Health Performance Assessment in a Close-Knit Medical Community).
                Categories
                Public Health
                Original Research
                Custom metadata
                Health Economics

                disorders of consciousness,stroke,intensive rehabilitation,hospitalization costs,length of stay

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