Identificador: TDX:610
Autores: San Segundo Mozo, Rosa Maria
Resumen:
The stroke is a common health problem in our society. It represents the third cause of mortality in the Western World and the first cause of mortality in Spain. In addition to having a high incidence rate, this pathology is also very prevalent. Although strokes are important cause of mortality, it causes more disabilities than deaths. The economic costs involved in strokes are very high due to the direct relationship between strokes and the high level of disabilities they provoke. Acute hospitalization and institutionalisation are very important parts of the economic costs of strokes. For this reason, we are interested in studying the factors which may provoke the association between these factors and the need for institutionalisation.Thesis applicationsThe institutionalisation of stroke victims can be influenced by multiple factors. While there are a lot of published estudies which attempt to explain which factors influence the degree of institutionalisation of these patients at discharge, there are none in our environment. The purpose of our work is to identify the factors which influence the institutionalisation of stroke victims.Objectives1) To study clinical and demographic factors upon admission which may foretell the institutionalisation of a stroke victim.2) To build algorithms of decision to predict the future of a patient at discharge from the hospital using the prediction factors found in point 1.3) To evaluate the clinical and sociodemographic differences between those hospitalized patients who are later institutionalized at discharge and those who are not.MethodologyThis is a historic cohort study which made use of stroke in-patients at Rehabilitation Services of Hospital Joan XXIII of Tarragona, from 1994 to 2001 inclusive. The study group is composed of 214 consecutive patients. The statistical study is carried out using descriptive, bivariable and multivariable analysis. The multivariable analysis is performed with a regressive lineal multiple analysis with a significant difference of p<0,05.Conclusions1) The clinical and demographic factors which most accurately predict the institutionalisation of stroke victims are: age, sex, functional performance, living alone, architectural barriers, comorbility, and left hemiparesis.2) The algorithm of decision for discharge is constructed with the three variables which most acurately predict the future of these patients: functional performance at admission, age and living alone. This algorithm has eight groups of different probabilities of institutionalisation from 3,6% to 79,6%.3) Regarding the clinical differences between institutionalized patients and non-institutionalized patients, we stress that of those patients with low functional performance at admission and under the age of 75, those which are institutionalized tend to have a low final functional performance after treatment (they improve less with treatment), despite being hospitalized for similar periods of time. Patients over 75 years of age and with low initial functional performance also improve less with treatment, but not proportionally less than the previous group and on the contrary spend less time as inpatients in acute hospitals.Results of the investigationUsing the media and participating in Congresses:1. VII Transpirenaic Congress of RHB. Toulouse. November 2003. Communications: ' A prediction model for institutionalisation of stroke victims'; 'Profile of institutionalized stroke victims'.2. 42nd National Congress SERMEF. Coruña 2004. 'Models of prediction for institutionalisation of stroke victims'.
Repositori URV