Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1903-1906 , October 2008

Impact of Comorbidities on Stroke Rehabilitation Outcomes: Does the Method Matter?

Presented in part to the Veterans Affairs Health Services Research and Development Service, February 16–17, 2006, Washington, DC.

  • Dan R. Berlowitz, MD, MPH

      Affiliations

    • Center for Health Quality, Outcomes and Economic Research, Bedford VA Hospital, Bedford, MA
    • Boston University Schools of Public Health and Medicine, Boston, MA
    • Corresponding Author InformationCorrespondence to Dan R. Berlowitz, MD, MPH, CHQOER (152), Bedford VA Hospital, 200 Springs Rd, Bedford, MA 01730
    • ,
  • Helen Hoenig, MD

      Affiliations

    • Physical Medicine and Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, NC
    • Duke University Medical Center, Durham, NC
    • ,
  • Diane C. Cowper, PhD

      Affiliations

    • Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
    • University of Florida, Gainesville, FL
    • ,
  • Pamela W. Duncan, PhD

      Affiliations

    • Duke Center for Clinical Health Policy Research, Durham, NC
    • Duke University Medical Center, Durham, NC
    • ,
  • W. Bruce Vogel, PhD

      Affiliations

    • Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
    • University of Florida, Gainesville, FL

References 

  1. Rao P, Boradia P, Ennis J. Shift happens: using outcomes to survive and thrive under PPS. Top Stroke Rehabil. 2005;12:1–3
  2. Hoenig H, Sloane R, Horner RD, Zolkewitz M, Reker D. Differences in rehabilitation services and outcomes among stroke patients cared for in Veterans hospitals. Health Serv Res. 2001;35:1293–1315
  3. Smith MA, Frytak JR, Liou J, Finch MD. Rehospitalization and survival for stroke patients in managed care and traditional Medicare plans. Med Care. 2005;43:902–910
  4. Deutsch A, Granger CV, Heinemann AW, et al. Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. Stroke. 2006;37:1477–1482
  5. Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Ostir GV, Granger CV. Trends in length of stay, living setting, functional outcomes, and mortality following medical rehabilitation. JAMA. 2004;292:1687–1695
  6. Iezzoni LI. The risks of risk adjustment. JAMA. 1997;278:1600–1607
  7. Kane RL. Improving outcomes in rehabilitation. Med Care. 1997;35:JS21–JS27
  8. Ottenbacher KJ, Smith PM, Illig SB, Fiedler RC, Gonzales V, Granger CV. Characteristics of persons rehospitalized after stroke rehabilitation. Arch Phys Med Rehabil. 2001;82:1367–1374
  9. Stineman MG, Tassoni CJ, Escare JJ, et al. Development of Function Related Groups Version 2.0: a classification system for medical rehabilitation. Health Serv Res. 1997;32:529–548
  10. Siegler EL, Stineman MG, Maislin G. Development of complications during rehabilitation. Arch Intern Med. 1994;154:2185–2190
  11. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27
  12. Kind AJH, Smith MA, Frytak JR, Finch MD. Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke. J Am Geriatr Soc. 2007;55:365–373
  13. Linacre JM, Heinemann AW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil. 1994;75:127–132
  14. Charlson ME, Pompei EP, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  15. Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452–472
  16. Ellis RP, Pope GC, Iezzoni L, et al. Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev. 1996;17:101–128
  17. Reker DM, Reid K, Duncan PW, et al. Development of an integrated stroke outcomes database within Veterans Health Administration. J Rehabil Res Dev. 2005;42:77–92
  18. Kashner TM. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36:1324–1336
  19. Borzecki AM, Wong AT, Hickey EC, Ash AS, Berlowitz DR. Identifying hypertension-related comorbidities from administrative data: what's the optimal approach?. Am J Med Qual. 2004;19:201–206
  20. Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil. 2006;87:32–39
  21. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619
  22. Iezzoni LI. Risk adjusting rehabilitation outcomes. Am J Phys Med Rehabil. 2004;83:316–326

 Supported by the Office of Research and Development Rehabilitation Research and Development Service, Department of Veterans Affairs (grant no. B3105-R).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints not available from the authors.

PII: S0003-9993(08)00526-1

doi: 10.1016/j.apmr.2008.03.024

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1903-1906 , October 2008

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