Timothy A Reistetter1, Amol M Karmarkar2, James E Graham2, Karl Eschbach3, Yong-Fang Kuo3, Carl V Granger4, Jean Freeman3, Kenneth J Ottenbacher2. 1. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX. Electronic address: tareiste@utmb.edu. 2. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX. 3. Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX. 4. Uniform Data System for Medical Rehabilitation, Buffalo, NY.
Abstract
OBJECTIVE: To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DESIGN: Retrospective cohort design. SETTING: Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. PARTICIPANTS: Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). RESULTS: Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. CONCLUSIONS: Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.
OBJECTIVE: To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DESIGN: Retrospective cohort design. SETTING: Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. PARTICIPANTS: Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). RESULTS: Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. CONCLUSIONS: Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.
Keywords:
CI; CMS; Centers for Medicare and Medicaid Services; Health services; IRF; IRF-PAI; Inpatient Rehabilitation Facility–Patient Assessment Instrument; LOS; OR; Quality of health care; Rehabilitation; SNF; UDSMR; Uniform Data System for Medical Rehabilitation; confidence interval; inpatient rehabilitation facility; length of stay; odds ratio; skilled nursing facility
Authors: Anne Deutsch; Carl V Granger; Allen W Heinemann; Roger C Fiedler; Gerben DeJong; Robert L Kane; Kenneth J Ottenbacher; John P Naughton; Maurizio Trevisan Journal: Stroke Date: 2006-04-20 Impact factor: 7.914
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Authors: C M Ashton; N J Petersen; J Souchek; T J Menke; H J Yu; K Pietz; M L Eigenbrodt; G Barbour; K W Kizer; N P Wray Journal: N Engl J Med Date: 1999-01-07 Impact factor: 91.245
Authors: Timothy A Reistetter; Yong-Fang Kuo; Amol M Karmarkar; Karl Eschbach; Srinivas Teppala; Jean L Freeman; Kenneth J Ottenbacher Journal: Arch Phys Med Rehabil Date: 2015-03-04 Impact factor: 3.966