Article

OBJECTIVE: To study the association of postacute care (PAC) settings and
mortality outcome of patients who sustained an ischemic stroke. DESIGN:
A retrospective cohort study. SETTING: An integrated health care system in northern
California. PARTICIPANTS: Patients who sustained an acute ischemic stroke between
1996 and 2004, survived the initial acute care hospital stay, and received PAC
services within 14 days of discharge (n = 16,538) and 61 days of discharge (n = 16,468). INTERVENTIONS: PAC rehabilitation ranked by resource level, that is,
inpatient rehabilitation hospital (IRH), skilled nursing facility (SNF), home
health (HH), and outpatient (OP) rehabilitation. MAIN OUTCOME MEASUREMENTS:
One-year mortality after acute care hospital discharge. RESULTS: The highest
level of PAC services received within 14 days of acute care discharge was IRH for
5.6% of patients, SNF for 48.3% of patients, HH for 18.9% of patients, and OP for
27.3% of patients. The highest level of PAC services received within 61 days of
acute care discharge was IRH for 10.9% of patients, SNF for 40.4% of patients, HH
for 19.1% of patients, and OP for 29.6% of patients. Cox proportional hazard
models showed that patients whose highest level of PAC service was provided by an
IRH, through HH, or OP had a significantly better 1-year survival than did those
admitted to an SNF. The following factors were associated with a higher risk of
1-year mortality: older age, male gender, African American ethnicity, history of
previous stroke, higher Deyo-Charlson comorbidity scores,
a longer acute care
hospital stay, and hospitalization in one remotely located health service area.
CONCLUSIONS: In the year after a stroke occurred, the rate of patient survival
varied based on PAC rehabilitation services. Age, gender, race or ethnicity,
history of a previous stroke, comorbid conditions, and service area also were
significantly associated with 1-year mortality after acute care discharge.
Further investigation of the differences in mortality among PAC settings is
indicated.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS