title: Inpatient stroke rehabilitation in Ontario: are dedicated units better?
abstract: BACKGROUND
  The superiority of dedicated stroke rehabilitation over generalized rehabilitation services has been suggested by the literature; however, these models of service delivery have not been evaluated in terms of their relative effectiveness in situ.
  
  
  OBJECTIVE
  A comparison of the process indicators associated with these two models of service provision was undertaken within the Ontario healthcare system.
  
  
  METHODS
  All adults admitted with a diagnosis of stroke for inpatient rehabilitation in Ontario, Canada during the years 2006-2008 were identified from the National Rehabilitation Reporting System database. Each of the admitting institutions was classified as providing rehabilitation services on either a stroke dedicated or nondedicated unit. A dedicated unit was identified by the presence of a collection of geographically distinct, stroke-dedicated beds and dedicated therapists. Selected process indicators from the National Rehabilitation Reporting System database were compared between the two facility types.
  
  
  RESULTS
  Sixty-seven facilities provided stroke rehabilitation services to 6709 adult stroke patients during the years 2006-2008. Of the total number of patients who entered inpatient rehabilitation, 1725 (25·7%) received care in eight facilities that met basic criteria for a dedicated stroke rehabilitation unit. On average, these patients took significantly longer to arrive for inpatient rehabilitation (37·2 ± 155·5 vs. 22·8 ± 95·0 days, P < 0·001), were admitted with higher Functional Independence Measure scores (77·5 ± 22·5 vs. 74·8 ± 24·5, P < 0·001), had significantly longer lengths of stay (42·1 ± 25·9 vs. 35·4 ± 27·2 days, P < 0·001), and demonstrated significantly lower Functional Independence Measure efficiency scores (0·62 ± 0·47 vs. 0·88 ± 1·03, P > 0·001) compared with patients who were admitted to nondedicated units. The proportion of patients admitted to a dedicated unit and subsequently discharged home was similar to that of patients discharged from nondedicated units (70·5% vs. 68·8%, P = 0·206).
  
  
  CONCLUSIONS
  In Ontario, patients admitted to dedicated stroke rehabilitation units fared no better on commonly-used process metrics compared with patients admitted to nondedicated rehabilitation units.
authors.affiliation: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital Site, London, Ontario, Canada. norine.foley@sjhc.london.on.ca
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Matthew
authors.initials: M
authors.lastname: Meyer
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: Mark
authors.initials: M
authors.lastname: Bayley
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.forename: Deborah
authors.initials: D
authors.lastname: Willems
authors.forename: J Andrew
authors.initials: JA
authors.lastname: McClure
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000368:Aged; D005260:Female; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D009864:Ontario; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000071939:Stroke Rehabilitation