TY - JOUR
T1 - Unexplained variation for hospitals' use of inpatient rehabilitation and skilled nursing facilities after an acute ischemic stroke
AU - Xian, Ying
AU - Thomas, Laine
AU - Liang, Li
AU - Federspiel, Jerome J.
AU - Webb, Laura E.
AU - Bushnell, Cheryl D.
AU - Duncan, Pamela W.
AU - Schwamm, Lee H.
AU - Stein, Joel
AU - Fonarow, Gregg C.
AU - Hoenig, Helen
AU - Montalvo, Cris
AU - George, Mary G.
AU - Lutz, Barbara J.
AU - Peterson, Eric D.
AU - Bettger, Janet Prvu
N1 - Funding Information:
All P values were 2 sided, with <0.05 being considered statistically significant. All statistical analyses were performed using SAS, version 9.4 (SAS Institute, Inc, Cary, NC). This study was approved by the Duke University Institutional Review Board and was funded by the Patient-Centered Outcomes Research Institute.
Funding Information:
Research funding from Patient-Centered Outcomes Research Institute (PCORI #130; PI: Bettger). Get With The Guidelines-Stroke is provided by the American Heart Association/American Stroke Association. Medicare files obtained with funding from the Agency for Healthcare Research and Quality (K12HS019479; PI: Oddone).
Funding Information:
Drs Xian, Bushnell, Duncan, Lutz, Bettger, and Peterson received additional research funding from Patient-Centered Outcomes Research Institute (PCORI). Drs Schwamm and Fonarow received research funding from PCORI and are a member of the Get With The Guidelines Steering Committee.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - Skilled nursing facilities
KW - Stroke
KW - Stroke rehabilitation
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U2 - 10.1161/STROKEAHA.117.016904
DO - 10.1161/STROKEAHA.117.016904
M3 - Article
C2 - 28830975
AN - SCOPUS:85030977642
SN - 0039-2499
VL - 48
SP - 2836
EP - 2842
JO - Stroke
JF - Stroke
IS - 10
ER -