Geographic and Facility Variation in Inpatient Stroke Rehabilitation: Multilevel Analysis of Functional Status

Timothy Reistetter, Yong Fang Kuo, Amol Karmarkar, Karl Eschbach, Srinivas Teppala, Jean L. Freeman, Kenneth Ottenbacher

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StateAccepted/In press - 2015

Fingerprint

Multilevel Analysis
Inpatients
Rehabilitation
Centers for Medicare and Medicaid Services (U.S.)
Stroke
Referral and Consultation
Geographic Locations
Stroke Rehabilitation
Cognition
Linear Models
Outcome Assessment (Health Care)

Keywords

  • Health policy
  • Health services
  • Outcome assessment (health care)
  • Quality indicators, health care
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Geographic and Facility Variation in Inpatient Stroke Rehabilitation : Multilevel Analysis of Functional Status. / Reistetter, Timothy; Kuo, Yong Fang; Karmarkar, Amol; Eschbach, Karl; Teppala, Srinivas; Freeman, Jean L.; Ottenbacher, Kenneth.

In: Archives of Physical Medicine and Rehabilitation, 2015.

Research output: Contribution to journalArticle

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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.",
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AU - Teppala, Srinivas

AU - Freeman, Jean L.

AU - Ottenbacher, Kenneth

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