Regional variation in stroke rehabilitation outcomes

Arch Phys Med Rehabil. 2014 Jan;95(1):29-38. doi: 10.1016/j.apmr.2013.07.018. Epub 2013 Aug 3.


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.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Centers for Medicare and Medicaid Services, U.S. / statistics & numerical data
  • Cognition
  • Female
  • Humans
  • Inpatients / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Discharge / statistics & numerical data*
  • Psychomotor Performance
  • Recovery of Function
  • Rehabilitation Centers / statistics & numerical data*
  • Residence Characteristics / statistics & numerical data*
  • Retrospective Studies
  • Socioeconomic Factors
  • Stroke Rehabilitation*
  • United States
  • Young Adult