title: Does postacute care site matter? A longitudinal study assessing functional recovery after a stroke.
abstract: OBJECTIVE
  To determine the impact of postacute care site on stroke outcomes.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four northern California hospitals that are part of a single health maintenance organization.
  
  
  METHODS
  Patients with stroke (N=222) enrolled between February 2008 and July 2010.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: Basic Mobility, Daily Activities, and Applied Cognition.
  
  
  RESULTS
  Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an inpatient rehabilitation facility (IRF) in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care.
  
  
  CONCLUSIONS
  Patients with stroke may make more functional gains if their postacute care includes an IRF. This finding may have important implications as postacute care delivery is reshaped through health care reform.
authors.affiliation: National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD 20892, USA. chanle@cc.nih.gov
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Sandel
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jette
authors.forename: Jed
authors.initials: J
authors.lastname: Appelman
authors.forename: Diane E
authors.initials: DE
authors.lastname: Brandt
authors.forename: Pengfei
authors.initials: P
authors.lastname: Cheng
authors.forename: Marian
authors.initials: M
authors.lastname: Teselle
authors.forename: Richard
authors.initials: R
authors.lastname: Delmonico
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Terdiman
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012866:Skilled Nursing Facilities; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D019467:Subacute Care