Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt

The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy

OBJECTIVE

To describe the costs of hospital care for acute stroke for patients with aphasia or dysarthria.

DESIGN

Observational study from the Stroke123 project.

SETTING

Data from patients admitted with stroke (2009-2013) from 22 hospitals in Queensland participating in the Australian Stroke Clinical Registry (AuSCR) were linked to administrative datasets.

PARTICIPANTS

Communication impairments were identified using International Classification of Diseases, 10th Revision, Australian Modification codes. Overall, 1043 of 4195 (25%) patients were identified with aphasia (49% were women; median age 78 years; 83% with ischemic stroke), and 1005 (24%) with dysarthria (42% were women; median age 76 years; 85% with ischemic stroke).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Linked patient-level, hospital clinical costing related to the stroke, were adjusted to 2013/2014 Australian dollars (AU$, US$ conversion x 0.691) using recommended national price indices and multivariable regression analysis with clustering by hospital performed.

RESULTS

Compared with patients without aphasia, the median hospital costs/patient were greater for those with aphasia for medical (aphasia AU$2273 vs AU$1727, P<.001), nursing (aphasia AU$3829 vs AU$2748, P<.001) and allied health services (aphasia AU$1138 vs AU$720, P<.001). Similarly, costs were greater for patients with dysarthria compared with those without dysarthria. Adjusted median total costs were AU$2882 greater for patients with aphasia compared with patients without aphasia (95% confidence interval, AU$1880-3884), and AU$843 greater for patients with dysarthria compared with those without dysarthria (95% confidence interval, AU$-301 to 1987).

CONCLUSIONS

People with communication impairment after stroke incur greater hospital costs, in particular for medical, allied health, and nursing resources.

Understanding the Economics of Aphasia: Recent Findings from Speech and Language Research

In recent years, stakeholders engaged in the study, treatment, and understanding of aphasia outcomes have emphasized the need for greater transparency regarding the economics of aphasia rehabilitation. Most notably, third-party payers and clinicians have a keen interest in understanding the resources used to treat aphasia, particularly the cost-effectiveness and value of aphasia treatments. In this article, we review the current literature related to the economic burden of aphasia and the cost and cost-effectiveness of aphasia treatments. To date, relatively few scholars have attempted to study the efficiency, scale, and scope related to the economics of aphasia and the cost-effectiveness of aphasia treatment. While studies of the cost-effectiveness of aphasia treatments have shown rehabilitative treatments conform to established quality and cost benchmarks, the continued progress and developments in the treatment of aphasia and measurement of clinical outcomes has left many areas unstudied. We highlight the need for greater emphasis on the cost-effectiveness of aphasia treatments in addition to the traditional focus on the efficacy of treatment outcomes.

Development and application of a Chinese Version of the Language Screening Test (CLAST) in post-stroke patients

Aphasia shows high incidence in stroke patients and seriously impairs language comprehension, verbal communication, and social activities. Therefore, screening aphasic patients during the acute phase of stroke is crucial for language recovery and rehabilitation. The present study developed a Chinese version of the Language Screening Test (CLAST) and validated it in post-stroke patients.The CLAST was adapted from the Language Screening Test developed by Constance et al to incorporate Chinese cultural and linguistic specificities, and administered to 207 acute stroke patients and 89 stabilized aphasic or non-aphasic patients. Based on the Western Aphasia Battery (WAB) test, its reliability and validity were assessed. A cut-off for the CLAST in Chinese patients was determined by ROC curve analysis.The CLAST comprised 5 subtests and 15 items, including 2 subscores, namely expression (8 points, assessing naming, repetition, and automatic speech) and receptive (7 points maximum, evaluating picture recognition, and verbal instructions) indexes. Analysis of the alternate-form reliability of the questionnaire showed a retest correlation coefficient of 0.945 (P < .001). Intraclass correlation coefficients of three rating teams were >0.98 (P < .001). Internal consistency analysis showed a Cronbach's alpha coefficient of 0.909 (P < .001). The non-aphasia group showed higher scores than the aphasia group (14.2 ± 1.3 vs 10.6 ± 3.8) (P < .01). The questionnaire showed good construct validity by factor analysis. ROC curve analysis showed high sensitivity and specificity for the CLAST, with a cut-off of 13.5.The CLAST is suitable for Chinese post-stroke patients during the acute phase, with high reliability, validity, sensitivity, and specificity.