Journal-based CME article| Volume 94, ISSUE 4, P622-629, April 2013

Does Postacute Care Site Matter? A Longitudinal Study Assessing Functional Recovery After a Stroke

Published:November 05, 2012DOI:https://doi.org/10.1016/j.apmr.2012.09.033

      Abstract

      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.

      Keywords

      List of abbreviations:

      ACO (accountable care organization), AM-PAC (Activity Measure for Post Acute Care), HH (home health care), IRF (inpatient rehabilitation facility), mCharlson (modified Charlson), MDC (minimal detectable change), mNIHSS (modified National Institutes of Health Stroke Scale), mRankin (modified Rankin), OP (outpatient), PPACA (Patient Protection and Affordable Care Act of 2010), SNF (skilled nursing facility)
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