Regional variation in stroke rehabilitation outcomes.

Reistetter TA1, Karmarkar AM2, Graham JE2, Eschbach K3, Kuo YF3, Granger CV4, Freeman J3, Ottenbacher KJ2.

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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.

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