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Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation

The aim of the study was to explore variation in acute care use of
inpatient rehabilitation facilities and skilled nursing facilities rehabilitation
after ischemic and hemorrhagic stroke. DESIGN: A secondary analysis of Medicare
claims data linked to inpatient rehabilitation facilities and skilled nursing
facilities assessment files (2013-2014) was performed.
RESULTS: The sample
included 122,084 stroke patients discharged to inpatient or skilled nursing
facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged
patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15)
compared with 1832 acute hospitals that discharged patients with hemorrhagic
events (range = 1-73 patients/hospital, median = 4). The intraclass correlation
coefficient examined variation in discharge settings attributed to acute
hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic
intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those
with greater numbers of co-morbid conditions were more likely to discharge to
skilled nursing facilities. Comparison of self-care and mobility across stroke
type suggests that patients with ischemic stroke have higher functional abilities
at admission. CONCLUSIONS: This study suggests demographic and clinical
differences among stroke patients admitted for postacute rehabilitation at
inpatient rehabilitation facilities and skilled nursing facilities settings.
Furthermore, examination of variation in ischemic and hemorrhagic stroke
discharges suggests acute facility-level differences and indicates a need for
careful consideration of patient and facility factors when comparing the
effectiveness of inpatient rehabilitation facilities and skilled nursing
facilities rehabilitation.

Langue : ANGLAIS

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