Article

OBJECTIVE: To determine the impact of postacute care site on stroke outcomes.
DESIGN: Prospective cohort study. SETTING: Four northern California hospitals
that are part of a single health maintenance organization. PARTICIPANTS: Patients
with stroke (N=222) enrolled between February 2008 and July 2010. INTERVENTION:
Not applicable. MAIN OUTCOME MEASURE: Baseline and 6-month assessments were
performed using the Activity Measure for Post Acute Care (AM-PAC), a test of
self-reported function in 3 domains: Basic Mobility, Daily Activities, and
Applied Cognition. RESULTS: Of the 222 patients analyzed, 36% went home with no
treatment, 22% received home health/outpatient care, 30% included an inpatient
rehabilitation facility (IRF) in their care trajectory, and 13% included a
skilled nursing facility (but not IRF) in their care trajectory. At 6 months,
after controlling for important variables such as age, functional status at acute
care discharge, and total hours of rehabilitation, patients who went to an IRF
had functional scores that were at least 8 points higher (twice the minimally
detectable change for the AM-PAC) than those who went to a skilled nursing
facility in all 3 domains and in 2 of 3 functional domains compared with those
who received home health/outpatient care. CONCLUSIONS: Patients with stroke may
make more functional gains if their postacute care includes an IRF. This finding
may have important implications as postacute care delivery is reshaped through
health care reform.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

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