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Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

Publication ,  Journal Article
Xian, Y; Thomas, L; Liang, L; Federspiel, JJ; Webb, LE; Bushnell, CD; Duncan, PW; Schwamm, LH; Stein, J; Fonarow, GC; Hoenig, H; Montalvo, C ...
Published in: Stroke
October 2017

BACKGROUND AND PURPOSE: Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. METHODS: We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. RESULTS: Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). CONCLUSIONS: There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT02284165.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2017

Volume

48

Issue

10

Start / End Page

2836 / 2842

Location

United States

Related Subject Headings

  • Stroke Rehabilitation
  • Stroke
  • Skilled Nursing Facilities
  • Registries
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospitalization
  • Female
  • Brain Ischemia
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Xian, Y., Thomas, L., Liang, L., Federspiel, J. J., Webb, L. E., Bushnell, C. D., … Bettger, J. P. (2017). Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke, 48(10), 2836–2842. https://doi.org/10.1161/STROKEAHA.117.016904
Xian, Ying, Laine Thomas, Li Liang, Jerome J. Federspiel, Laura E. Webb, Cheryl D. Bushnell, Pamela W. Duncan, et al. “Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.Stroke 48, no. 10 (October 2017): 2836–42. https://doi.org/10.1161/STROKEAHA.117.016904.
Xian Y, Thomas L, Liang L, Federspiel JJ, Webb LE, Bushnell CD, et al. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke. 2017 Oct;48(10):2836–42.
Xian, Ying, et al. “Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.Stroke, vol. 48, no. 10, Oct. 2017, pp. 2836–42. Pubmed, doi:10.1161/STROKEAHA.117.016904.
Xian Y, Thomas L, Liang L, Federspiel JJ, Webb LE, Bushnell CD, Duncan PW, Schwamm LH, Stein J, Fonarow GC, Hoenig H, Montalvo C, George MG, Lutz BJ, Peterson ED, Bettger JP. Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke. 2017 Oct;48(10):2836–2842.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2017

Volume

48

Issue

10

Start / End Page

2836 / 2842

Location

United States

Related Subject Headings

  • Stroke Rehabilitation
  • Stroke
  • Skilled Nursing Facilities
  • Registries
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospitalization
  • Female
  • Brain Ischemia