The development of an integrated care plan for post stroke patients (iCaPPS) residing at home in the Malaysian community: A study assessing impact on quality of life and cost effectiveness

Abstract

The delivery of post discharge stroke care has been fragmented even in the best of public health systems around the world. This study aimed to develop an integrated care pathway for post stroke (iCaPPS) patients residing at home in the community and evaluate its impact on quality of life and cost effectiveness, compared to conventional care practices. First phase of the study assessed self-reported practices in management of post stroke by Family Medicine Specialists (FMS) at primary care public health centres. This survey finding was then used to guide an expert panel in the development of the iCaPPS. A cluster randomised controlled trial was conducted to compare the cost and outcomes of iCaPPS with conventional care. Costs were estimated from the societal perspective. The primary outcome was measured by changes in quality of life (EQ5D-5L). A total of 151 stroke survivors from ten selected public health centres in Peninsular Malaysia, participated in the trial. Incremental cost effectiveness ratio was determined by changes in cost per unit quality-adjusted life year (QALY) calculated for the trial. The expert panel identified care algorithms for identifying and treating patients who required multidisciplinary rehabilitation as well as leisure interventions, screening for swallowing disorders and mental health complications. Indications for referral to Specialists were outlined and periodic screenings for stroke-related complications were scheduled. Gain in QALY for iCaPPS was higher than conventional care (0.55 vs. 0.32) and cost per QALY gained for iCaPPS was lower than conventional care (RM1,436 vs. RM 1,647). For CEA, the iCaPPS was more cost-effective than the conventional care, with ICER of RM1,144 per additional QALY gained which is less than one gross domestic product per capita (GDP), for 2012. In conclusion, the iCaPPS improved the quality of life of post stroke patients residing at home in the community and proven to be cost-effective.