Regional variation in stroke rehabilitation outcomes.
OBJECTIVE
To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation.


METHODS
Retrospective cohort design.


METHODS
Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States.


METHODS
Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007.


METHODS
Not applicable.


METHODS
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.
Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX. Electronic address: tareiste@utmb.edu.
Timothy A
TA
Reistetter
Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
Amol M
AM
Karmarkar
Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
James E
JE
Graham
Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
Karl
K
Eschbach
Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
Yong-Fang
YF
Kuo
Uniform Data System for Medical Rehabilitation, Buffalo, NY.
Carl V
CV
Granger
Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
Jean
J
Freeman
Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
Kenneth J
KJ
Ottenbacher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D003071:Cognition; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011597:Psychomotor Performance; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D014481:United States; D055815:Young Adult
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