Variation in Post-Acute Care Transitions for Medicare Beneficiaries With Stroke

Objective To examine the variability in post-acute care trajectories over 90 days across various settings for patients with stroke and the factors that influence this variability. Design A retrospective cohort study used Medicare claims data from acute hospitals linked with post-acute assessment data from 3 post-acute settings: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). Setting and Participants The study focused on traditional Medicare beneficiaries with stroke who were discharged from the acute hospital from October 31, 2016, to September 30, 2019, and followed them for 90 days. We examined the patterns of post-acute care transitions over 90 days across multiple settings, from acute hospitals to IRFs, SNFs, and HHAs. Methods Identified 7 patterns for post-acute transitions within 90 days after discharge from acute hospitals: (1) none, (2) HHA-none, (3) IRF-HHA, (4) IRF-none, (5) IRF-SNF, (6) SNF-HHA, and (7) SNF-none. Using the “none” category as the reference, we computed regression models to examine the association of patient-, facility-, and hospital referral region–level variables across categories. Results Approximately 35% of patients did not receive any post-acute care after acute hospitalization, followed by 28% receiving index post-acute care at IRF, 24% at SNF, and 13% through HHA. In fully adjusted regression models, using “none” as the reference category, dual-eligible Medicare and Medicaid patients have experienced greater likelihood of all post-acute care transitions, indicating a greater need to improve the care coordination efficiency for this population: HHA-none [odds ratio (OR 1.7, 95% CI 1.6-1.7], IRF-HHA (OR 1.6, 95% CI 1.5-1.6), IRF-none (OR 1.2, 95% CI 1.1-1.2), IRF-SNF (OR 3.5, 95% CI 3.3-3.6), SNF-HHA (OR 2.1, 95% CI 2-2.2), and SNF-none (OR 4.2, 95% CI 4.1-4.4). Conclusions and Implications With the advent of value-based payment models, care coordination has become the epitome to achieve efficiency in care transitions from acute to post-acute care. Our findings could help develop strategies to improve the continuity of care in patients with stroke with the goal to improve poststroke rehabilitation care and services.