Regional variation in stroke rehabilitation outcomes

Abstract

Objective: To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation.

Design: Retrospective cohort design.

Setting: Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States.

Participants: Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007.

Interventions: Not applicable.

Main outcome measures: Community discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS).

Results: Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days.

Conclusions: Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.

Keywords: CI; CMS; Centers for Medicare and Medicaid Services; Health services; IRF; IRF-PAI; Inpatient Rehabilitation Facility–Patient Assessment Instrument; LOS; OR; Quality of health care; Rehabilitation; SNF; UDSMR; Uniform Data System for Medical Rehabilitation; confidence interval; inpatient rehabilitation facility; length of stay; odds ratio; skilled nursing facility.

Figure 1

Conceptual model for variation in stroke rehabilitation dependent on three components: Demographic factors, clinical factors, and geographic region.

Figure 2

Regional differences in LOS after adjusting for demographic and clinical factors across CMS regions. National median was 16.6 days (CMS 10). Lighter areas reflect shorter LOS. LOS varied by two days across the CMS regions.

Figure 3

Percentage of individuals discharged to the community following stroke rehabilitation after adjusting for demographic and clinical factors. Community discharge varied by 20% across the CMS regions.