Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project A. Ward a , K. A. Payne b , J. J. Caro a,c , P. U. Heuschmann d and P. L. Kolominsky-Rabas e a Caro Research Institute, Concord, MA, USA; b Caro Research Institute, Montreal, Quebec, Canada; c Division of General Internal Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada; d Institute of Epidemiology and Social Medicine, University of Muenster, Germany; e Unit for Stroke Research and Public Health Medicine, University of Erlangen, Bavaria, Germany Keywords: acute ischemic stroke, care needs, costs, Erlangen Stroke Project, Germany Received 17 May 2004 Accepted 7 July 2004 The objective was to determine the functional outcome, location of care and economic consequences in the first 3 months after ischemic stroke. As part of the Erlangen Stroke Project, (ESPro) information was collected on patients suffering a first-ever ischemic stroke. Three months after the stroke, location of care, dependence on caregivers and function based on Barthel Index: poor (0–55), moderate (60–90) or good function (95–100) were recorded. Data about health services used were combined with cost estimates for Germany (2000 Euros, undiscounted). Of 491 patients hos- pitalized, 383 were alive 3 months afterwards, 79% residing in the community. The majority of patients with poor function (60%) were still in institutional care. Patients with good function typically accrued the lowest costs, whether in an institution (17 965) or not (11 032) compared with poorer function who were living in an insti- tution (poor: 26 370; moderate: 28,121), or community (poor: 27,207; moderate: 19,350). Hospitalization and rehabilitation services were the major costs accrued at each level of function. Many patients were left requiring a substantial amount of care and the costs associated with providing institutional care has a major impact on the economic consequences of a stroke. One million acute ischemic strokes are estimated to occur in Europe each year (Hankey and Warlow, 1999) and many survivors are left with serious functional disabilities (Wolfe et al., 1999). The length of stay in an institution is the main factor influencing the costs accrued during the acute phase immediately after a stroke. (Jorgensen et al., 1997). National estimates of the costs of stroke cannot be readily transferred between countries, as there is evidence of variation both within and between countries in the way the system delivers health care, clinical practice and outcomes (Harvey et al., 1998; Grieve et al., 2001a,b). The pur- pose of this study was to determine the functional outcome, location of care, services used and the direct medical costs in the 3 months after a first ischemic stroke in Germany. Research design and methods The ESPro is a prospective, community-based registry designed to determine stroke incidence and case fatality rates among 101 450 residents of Erlangen, a town in southern Germany (Kolominsky-Rabas et al., 1998, 2001; Heuschmann et al., 2001). The database had records for all patients diagnosed with their first is- chemic, hemorrhagic, or unspecified stroke between April 1, 1994 and March 31, 1998. We evaluated the subset of patients hospitalized for treatment of their first ischemic stroke and with Barthel Index (BI) (Ma- honey and Barthel, 1965) scores at 3 months. Outcomes at 3 months were evaluated using three measures: function, dependence, and location of care. The functional categories were: poor (BI 0–55), moderate (BI 60–90) and good function (BI 95–100). Patients were defined as dependent using a subset of eight items from the Functional Index Measure instrument (FIM) (Granger et al., 1986; Stineman et al., 1997). A patient achieving this level of independence can eat, groom and dress without assistance, manage bladder and bowel function without accidents, and manage toilet functions once set up. The patient may still require supervision for transfer between bed to chair, and to either walk or propel a wheelchair 50 feet but with minimal assistance. Their use of health and social services from stroke onset to 3 months afterwards and final location of care was recorded. The patient’s location of care was clas- sified as either institutionalized (either remaining on a hospital ward, in a rehabilitation unit, or living in a nursing home) or community (living at home or in a residential facility). Correspondence: Alexandra Ward, Caro Research, 336 Baker Avenue, Concord, MA 01742, USA (tel.: +1 978 371 1660; fax: +1 978 371 2445; e-mail: alexward@caroresearch.com). 264 Ó 2005 EFNS European Journal of Neurology 2005, 12: 264–267