Effectiveness of post-acute care for patients with cerebral vascular disease in Taiwan between 2014 and 2023: a narrative synthesis

Cheng-Che Wu¹Chang-Cheng Wu¹Kuan-Chia Lin^2*

• ¹Department of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
• ²Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei City, Taiwan

Objectives To explore the overall effectiveness of Post-Acute Care-Cerebral Vascular Diseases (PAC-CVD) program in Taiwan implemented since 2014. Data Sources A systematic search of databases, PubMed and Google Scholar, was conducted. Eligible studies published between Jan 2014 to June 2023 were included. Study Selection Studies included those that explored stroke care; involved post-acute care; conducted in Taiwan; had focus on inpatient model of PAC-CVD program; and had either quantitative or qualitative design. 23 articles were identified and included for narrative synthesis after complete examination. Data Extraction The research articles were independently extracted by multiple observers following the guidance of article objectives focusing on outcomes of patients, quality of care, influence of referral system, cost-effectiveness, or outcome prediction of PAC-CVD program. Data Synthesis The PAC groups showed significantly better performance in most of indicators for functional outcome, quality of care, and cost-effectiveness than non-PAC groups. Patients involved in intra-hospital referral pattern or in hospitals of tie partnership had better outcomes. Younger age, ischemic stroke, and better baseline condition, especially in balance function, were strong predictive factors for prognosis of stroke patients in the PAC program. Conclusions The PAC-CVD program, implemented in Taiwan by changing payment system for healthcare providers to reimbursements of per-diem payment mode and establishing an integrated healthcare system, not just enhanced functional recovery and quality of life of acute stroke patients, but also improved quality of health care. It also offered a more efficient & effective care model for acute stroke patients by reducing medical expenditures. However, the PAC program has also increased the workload of clinical healthcare professionals under relative low-priced payment. The successful PAC-CVD implementation indicates the possibility of standard rehabilitative care model for acute stroke patients, and expansion to other diseases or conditions after adjustments to the payment structure and workload.