The Impact of Taiwan's Nationwide Postacute Care Program on Functional Recovery, Health Care Utilization, and Cost-Effectiveness for Patients With Stroke: A Systematic Review and Meta-Analysis.

Abstract

To synthesize and meta-analyze the clinical and economic impacts of Taiwan's nationwide Post-Acute Care for Cerebrovascular Disease (PAC-CVD) program regarding functional recovery, health care utilization, and cost-effectiveness within a single-payer system. PubMed, Embase, Scopus, Cochrane Library, and Airiti Library were searched from March 2014 through August 2025 using MeSH and keywords (Stroke, Postacute care). Quantitative observational cohorts and economic evaluations of the PAC-CVD program, including single-group pre-post studies and quasi-experimental designs comparing PAC with traditional care using propensity score matching. Two independent reviewers extracted data on functional scores (Barthel Index [BI], Berg Balance Scale [BBS]), disability (modified Rankin Scale [mRS]), readmissions, and costs. Quality was assessed via the Newcastle-Ottawa Scale. Thirty-three studies involving >10,000 stroke survivors were included. Meta-analysis showed substantial gains: pooled BI improvement was +25.4 (95% confidence interval [CI]: 23.3-27.5) and BBS +16.3 (95% CI: 14.6-18.0). The mRS change was -0.71 (95% CI: -0.74 to -0.68). Compared with traditional care, PAC demonstrated superior recovery (mean difference in BI change: +9.5, 95% CI: 3.8-15.2), significantly lower 30-day readmissions, and nearly 50% reduction in acute care costs ($5,848 vs $11,061). Subgroup analyses revealed high heterogeneity (I²=70.4%) in BI gains, influenced by stroke severity, and age. Grading of Recommendations, Assessment, Development, and Evaluations certainty was moderate for disability reduction (mRS) but low for functional gains because of heterogeneity. The nationwide PAC-CVD program is associated with significantly enhanced functional independence and offers a cost-effective alternative to traditional rehabilitation. Although promising, attenuated gains in older and severely disabled subgroups suggest a need for personalized "PAC-Plus" strategies integrating comprehensive geriatric assessment and intervention. This model serves as a scalable template for aging societies seeking to bridge the gap between acute and long-term care systems worldwide.