Stroke rehabilitation in nursing homes: how do we measure quality?

Over one-third of Medicare stroke patients are admitted to nursing homes for rehabilitation. Patients with stroke who are admitted to nursing homes are extremely heterogeneous, including both those with minimal physical and cognitive impairment and those who are totally physically dependent. Quality measures that are appropriate for evaluating stroke care in nursing homes include outcome measures, particularly those that are patient-centered, such as self-reported functional recovery and return to the community; process measures involving essential services such as screening for depression and pain; and structural measures such as the availability of a psychologist or presence of an interdisciplinary team. In measuring quality, nursing home professionals must allow sufficient time for outcomes to unfold, such as 3 to 6 months, rather than measuring outcome at discharge from a setting. Nursing home professionals must also take into consideration patient heterogeneity in terms of risk factors for outcomes of interest.