Abstract
Objectives
To synthesize research comparing poststroke health outcomes between patients rehabilitated
in skilled nursing facilities (SNFs) and those in inpatient rehabilitation facilities
(IRFs) as well as to evaluate relations between facility characteristics and outcomes.
Data Sources
PubMed and CINAHL searches spanned January 1, 1998, to October 6, 2016, and encompassed
MeSH and free-text keywords for stroke, IRF/SNF, and study outcomes. Searches were
restricted to peer-reviewed research in humans published in English.
Study Selection
Observational and experimental studies examining outcomes of adult patients with stroke
rehabilitated in an IRF or SNF were eligible. Studies had to provide site of care
comparisons and/or analyses incorporating facility-level characteristics and had to
report ≥1 primary outcome (discharge setting, functional status, readmission, quality
of life, all-cause mortality). Unpublished, single-center, descriptive, and non-US
studies were excluded. Articles were reviewed by 1 author, and when uncertain, discussion
with study coauthors achieved consensus. Fourteen titles (0.3%) were included.
Data Extraction
The types of data, time period, size, design, and primary outcomes were extracted.
We also extracted 2 secondary outcomes (length of IRF/SNF stay, cost) when reported
by included studies. Effect measures, modeling approaches, methods for confounding
adjustment, and potential confounders were extracted. Data were abstracted by 1 author,
and the accuracy was verified by a second reviewer.
Data Synthesis
Two studies evaluating community discharge, 1 study evaluating the predicted probability
of readmission, and 3 studies evaluating all-cause mortality favored IRFs over SNFs.
Functional status comparisons were inconsistent. No studies evaluated quality of life.
Two studies confirmed increased costs in the IRF versus SNF setting. Although substantial
facility variation was described, few studies characterized sources of variation.
Conclusions
The few studies comparing poststroke outcomes indicated better outcomes (with higher
costs) for patients in IRFs versus those in SNFs. Contemporary research on the role
of the postacute care setting and its attributes in determining health outcomes should
be prioritized to inform reimbursement system reform.
Keywords
List of abbreviations:
IRF (inpatient rehabilitation facility), LTCH (long-term care hospital), MedPAC (Medicare Payment Advisory Commission), PPS (prospective payment system), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 28, 2017
Footnotes
Supported by the National Institutes of Health (grant no. 5 TL1 TR 1454-3).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
