Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation

Ickpyo Hong, Amol Karmarkar, Winston Chan, Yong Fang Kuo, Trudy Mallinson, Kenneth Ottenbacher, James Goodwin, Clark R. Andersen, Timothy Reistetter

Research output: Contribution to journalArticle

Abstract

Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.

Original languageEnglish (US)
Pages (from-to)636-645
Number of pages10
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume97
Issue number9
DOIs
StatePublished - Sep 1 2018

Fingerprint

Rehabilitation Nursing
Skilled Nursing Facilities
Inpatients
Stroke
Rehabilitation
Insurance Claim Review
Nursing Assessment
Self Care
Medicare
Demography

Keywords

  • Inpatient Rehabilitation Facilities
  • Rehabilitation
  • Skilled Nursing Facilities
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation. / Hong, Ickpyo; Karmarkar, Amol; Chan, Winston; Kuo, Yong Fang; Mallinson, Trudy; Ottenbacher, Kenneth; Goodwin, James; Andersen, Clark R.; Reistetter, Timothy.

In: American Journal of Physical Medicine and Rehabilitation, Vol. 97, No. 9, 01.09.2018, p. 636-645.

Research output: Contribution to journalArticle

@article{28e44627f05e44fa82c78840dcdb0e4e,
title = "Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation",
abstract = "Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.",
keywords = "Inpatient Rehabilitation Facilities, Rehabilitation, Skilled Nursing Facilities, Stroke",
author = "Ickpyo Hong and Amol Karmarkar and Winston Chan and Kuo, {Yong Fang} and Trudy Mallinson and Kenneth Ottenbacher and James Goodwin and Andersen, {Clark R.} and Timothy Reistetter",
year = "2018",
month = "9",
day = "1",
doi = "10.1097/PHM.0000000000000932",
language = "English (US)",
volume = "97",
pages = "636--645",
journal = "American Journal of Physical Medicine and Rehabilitation",
issn = "0894-9115",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation

AU - Hong, Ickpyo

AU - Karmarkar, Amol

AU - Chan, Winston

AU - Kuo, Yong Fang

AU - Mallinson, Trudy

AU - Ottenbacher, Kenneth

AU - Goodwin, James

AU - Andersen, Clark R.

AU - Reistetter, Timothy

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.

AB - Objective The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. Results The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusions This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.

KW - Inpatient Rehabilitation Facilities

KW - Rehabilitation

KW - Skilled Nursing Facilities

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85051795657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85051795657&partnerID=8YFLogxK

U2 - 10.1097/PHM.0000000000000932

DO - 10.1097/PHM.0000000000000932

M3 - Article

C2 - 29595584

AN - SCOPUS:85051795657

VL - 97

SP - 636

EP - 645

JO - American Journal of Physical Medicine and Rehabilitation

JF - American Journal of Physical Medicine and Rehabilitation

SN - 0894-9115

IS - 9

ER -