title: Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Rehabilitation Medicine, School of Medicine and Biomedical Sciences, The State University of New York, Uniform Data System for Medical Rehabilitation, Amherst, NY, USA. a-deutsch@northwestern.edu
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.forename: Carl V
authors.initials: CV
authors.lastname: Granger
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.forename: Roger C
authors.initials: RC
authors.lastname: Fiedler
authors.forename: Gerben
authors.initials: G
authors.lastname: DeJong
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
authors.forename: John P
authors.initials: JP
authors.lastname: Naughton
authors.forename: Maurizio
authors.initials: M
authors.lastname: Trevisan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients; D008297:Male; D006278:Medicare; D009069:Movement Disorders / Q000209:etiology / Q000503:physiopathology; D012047:Rehabilitation Centers / Q000191:economics*; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities / Q000191:economics*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome