TY - JOUR
T1 - Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation
AU - Hong, Ickpyo
AU - Karmarkar, Amol
AU - Chan, Winston
AU - Kuo, Yong Fang
AU - Mallinson, Trudy
AU - Ottenbacher, Kenneth J.
AU - Goodwin, James S.
AU - Andersen, Clark R.
AU - Reistetter, Timothy A.
N1 - Funding Information:
This study was supported with funding from the Agency for Healthcare Quality and Research (R01-HS024711, R24-HS022134), National Institutes of Health (R01-AG033134, P2C-HD065702, R01-HD069443, K01-HD086290, 5P30-AG024832, and UL1TR000071). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0894-9115 DOI: 10.1097/PHM.0000000000000932
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AB - Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
KW - Inpatient Rehabilitation Facilities
KW - Rehabilitation
KW - Skilled Nursing Facilities
KW - Stroke
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U2 - 10.1097/PHM.0000000000000932
DO - 10.1097/PHM.0000000000000932
M3 - Article
C2 - 29595584
AN - SCOPUS:85051795657
VL - 97
SP - 636
EP - 645
JO - American Journal of Physical Medicine and Rehabilitation
JF - American Journal of Physical Medicine and Rehabilitation
SN - 0894-9115
IS - 9
ER -