Abstract
Objective
To examine geographic and facility variation in cognitive and motor functional outcomes
after postacute inpatient rehabilitation in patients with stroke.
Design
Retrospective cohort design using Centers for Medicare and Medicaid Services (CMS)
claims files. Records from 1209 rehabilitation facilities in 298 hospital referral
regions (HRRs) were examined. Patient records were analyzed using linear mixed models.
Multilevel models were used to calculate the variation in outcomes attributable to
facilities and geographic regions.
Setting
Inpatient rehabilitation units and facilities.
Participants
Patients (N=145,460) with stroke discharged from inpatient rehabilitation from 2006
through 2009.
Intervention
Not applicable.
Main Outcome Measures
Cognitive and motor functional status at discharge measured by items in the CMS Inpatient
Rehabilitation Facility–Patient Assessment Instrument.
Results
Variation profiles indicated that 19.1% of rehabilitation facilities were significantly
below the mean functional status rating (mean ± SD, 81.58±22.30), with 221 facilities
(18.3%) above the mean. Total discharge functional status ratings varied by 3.57 points
across regions. Across facilities, functional status values varied by 29.2 points,
with a 9.1-point difference between the top and bottom deciles. Variation in discharge
motor function attributable to HRR was reduced by 82% after controlling for cluster
effects at the facility level.
Conclusions
Our findings suggest that variation in motor and cognitive function at discharge after
postacute rehabilitation in patients with stroke is accounted for more by facility
than geographic location.
Keywords
List of abbreviations:
CMS (Centers for Medicare and Medicaid Services), HRR (hospital referral region), ICC (intraclass correlation coefficient), IOM (Institute of Medicine), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility–Patient Assessment Instrument), MedPAR (Medicare Provider Analysis and Review), POS (Provider of Service)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 04, 2015
Footnotes
Supported by the National Institutes of Health, National Institute of Child Health and Human Development, the National Center for Medical Rehabilitation Research (grant nos. K01-HD068513, R24-HD065702, R01-HD069443, K12-HD055929); National Institute on Aging (grant no. P30-AG024832); National Center for Advancing Translational Sciences (grant no. UL1TR000071); Agency for Healthcare Research and Quality (grant no. R24HS022134); and National Institute on Disability and Rehabilitation Research (grant no. H133P110012).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
