Inpatient rehabilitation after stroke: a comparison of lengths of stay and outcomes in the Veterans Affairs and non-Veterans Affairs health care system.
BACKGROUND
Patients have longer lengths of hospital stay (LOS) in VA medical centers than in the general health care system.


OBJECTIVE
The objective of this study was to determine whether resource use and outcome differences between VA and non-VA inpatient rehabilitation facilities remain after controlling for patient and medical care delivery differences.


METHODS
This analysis involved 60 VA inpatient rehabilitation units and 467 non-VA rehabilitation hospitals and units. Multivariate adjusted resource use and patient outcome differences were compared across setting within patients grouped by severity of disability at admission through assignment to the Function Related Group (FRG) patient classification system.


METHODS
The study included 55,438 stroke patients.


METHODS
Study measures were LOS, functional status at discharge, and community discharge.


RESULTS
The VA serves a higher proportion of patients who are single, separated, or divorced; are unemployed or retired as a result of disability, and are not white (P < 0.0001). These traits tended to be associated with longer LOS, lower functional outcomes, and reduced rates of community discharge. After adjusting for these and other differences, depending on FRG, average LOS remained from 30% to 200% longer in the VA centers (P < 0.05); average functional outcomes were significantly higher in 8 and lower in 2 FRGs (P < 0.05); and community discharge rates were lower in 12 FRGs (P < 0.05).


CONCLUSIONS
While certain variables accounted for some of the observed differences in resource use and outcomes, differences remained after adjustment. Fewer incentives for cost containment and less support in patients' home environments may be among the most important unmeasured determinants of VA differences.
Stineman
M G
MG
Department of Rehabilitation Medicine, Leonard Davis Institute of Health Economics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
Ross
R N
RN
Hamilton
B B
BB
Maislin
G
G
Bates
B
B
Granger
C V
CV
Asch
D A
DA
D000203:Activities of Daily Living; D000368:Aged; D003363:Cost Control; D003953:Diagnosis-Related Groups / Q000145:classification; D005260:Female; D015577:Geriatric Assessment; D006302:Health Services Research; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012944:Social Support; D000071939:Stroke Rehabilitation; D014481:United States; D014493:United States Department of Veterans Affairs; D014600:Utilization Review