Poststroke rehabilitation

Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs

Anne Deutsch, Carl V. Granger, Allen W. Heinemann, Roger C. Fiedler, Gerben DeJong, Robert L. Kane, Kenneth Ottenbacher, John P. Naughton, Maurizio Trevisan

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. METHODS - Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. RESULTS - IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. CONCLUSIONS - For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

Original languageEnglish (US)
Pages (from-to)1477-1482
Number of pages6
JournalStroke
Volume37
Issue number6
DOIs
StatePublished - Jun 2006

Fingerprint

Inpatients
Rehabilitation
Skilled Nursing Facilities
Rehabilitation Nursing
Medicare Part A
Medicare
Odds Ratio
Episode of Care
Information Systems
Cost-Benefit Analysis
Stroke
Outcome Assessment (Health Care)
Costs and Cost Analysis

Keywords

  • Cerebrovascular accident
  • Outcomes
  • Rehabilitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Deutsch, A., Granger, C. V., Heinemann, A. W., Fiedler, R. C., DeJong, G., Kane, R. L., ... Trevisan, M. (2006). Poststroke rehabilitation: Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. Stroke, 37(6), 1477-1482. https://doi.org/10.1161/01.STR.0000221172.99375.5a

Poststroke rehabilitation : Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. / Deutsch, Anne; Granger, Carl V.; Heinemann, Allen W.; Fiedler, Roger C.; DeJong, Gerben; Kane, Robert L.; Ottenbacher, Kenneth; Naughton, John P.; Trevisan, Maurizio.

In: Stroke, Vol. 37, No. 6, 06.2006, p. 1477-1482.

Research output: Contribution to journalArticle

Deutsch, A, Granger, CV, Heinemann, AW, Fiedler, RC, DeJong, G, Kane, RL, Ottenbacher, K, Naughton, JP & Trevisan, M 2006, 'Poststroke rehabilitation: Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs', Stroke, vol. 37, no. 6, pp. 1477-1482. https://doi.org/10.1161/01.STR.0000221172.99375.5a
Deutsch, Anne ; Granger, Carl V. ; Heinemann, Allen W. ; Fiedler, Roger C. ; DeJong, Gerben ; Kane, Robert L. ; Ottenbacher, Kenneth ; Naughton, John P. ; Trevisan, Maurizio. / Poststroke rehabilitation : Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs. In: Stroke. 2006 ; Vol. 37, No. 6. pp. 1477-1482.
@article{3005624059ba4be7b6a8b4ab8b4219a8,
title = "Poststroke rehabilitation: Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs",
abstract = "BACKGROUND AND PURPOSE - To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. METHODS - Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. RESULTS - IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95{\%} CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95{\%} CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95{\%} CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95{\%} CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. CONCLUSIONS - For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.",
keywords = "Cerebrovascular accident, Outcomes, Rehabilitation",
author = "Anne Deutsch and Granger, {Carl V.} and Heinemann, {Allen W.} and Fiedler, {Roger C.} and Gerben DeJong and Kane, {Robert L.} and Kenneth Ottenbacher and Naughton, {John P.} and Maurizio Trevisan",
year = "2006",
month = "6",
doi = "10.1161/01.STR.0000221172.99375.5a",
language = "English (US)",
volume = "37",
pages = "1477--1482",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Poststroke rehabilitation

T2 - Outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs

AU - Deutsch, Anne

AU - Granger, Carl V.

AU - Heinemann, Allen W.

AU - Fiedler, Roger C.

AU - DeJong, Gerben

AU - Kane, Robert L.

AU - Ottenbacher, Kenneth

AU - Naughton, John P.

AU - Trevisan, Maurizio

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND AND PURPOSE - To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. METHODS - Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. RESULTS - IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. CONCLUSIONS - For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

AB - BACKGROUND AND PURPOSE - To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs. METHODS - Clinical data were linked with Medicare claims for 58 724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay. RESULTS - IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups. CONCLUSIONS - For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.

KW - Cerebrovascular accident

KW - Outcomes

KW - Rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=33745127393&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745127393&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000221172.99375.5a

DO - 10.1161/01.STR.0000221172.99375.5a

M3 - Article

VL - 37

SP - 1477

EP - 1482

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -