Original research| Volume 100, ISSUE 7, P1218-1225, July 2019

Use of Hospital-Based Rehabilitation Services and Hospital Readmission Following Ischemic Stroke in the United States

Published:January 23, 2019DOI:


      • Higher intensity of rehabilitation care was associated with lower risk of 30-day hospital readmission.
      • Hospitals with rehabilitation units were associated with lower risk of 30-day hospital readmission.
      • Hospitals need to integrate rehabilitation care to achieve better outcomes in value-based reimbursement environments.



      To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.


      Secondary analysis of inpatient Medicare claims data using Standard Analytical Files.


      Acute hospitals across the United States.


      From nationwide data, Medicare fee-for-service beneficiaries (N=88,826) aged 66 years or older hospitalized for ischemic stroke between January to November 2010.


      Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.

      Main Outcome Measures

      All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.


      In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission. For low PT (30 minutes), the odds ratio (OR) was 0.90 (95% confidence interval [CI], 0.83-0.96). For medium PT (>30 to ≤75 minutes), the OR was 0.89 (95% CI, 0.82-0.95). For high PT (>75 minutes), the OR was 0.86 (95% CI, 0.80-0.93).


      Hospital-based PT services were associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.


      List of abbreviations:

      CCW (chronic condition warehouse), CMS (Centers for Medicare & Medicaid Services), FFS (fee-for-service), HH (home health care), ICU (intensive care unit), IRF (inpatient rehabilitation facility), OT (occupational therapy), PT (physical therapy), SAF (Standard Analytical File), SNF (skilled nursing facility), tPA (tissue plasminogen activator)
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