title: Poststroke Rehabilitation and Restorative Care Utilization: A Comparison Between VA Community Living Centers and VA-contracted Community Nursing Homes.
abstract: BACKGROUND
  Effective poststroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. Veterans affairs (VA) community living centers (CLCs) and VA-contracted community nursing homes (CNHs) are the 2 major sources of institutional long-term care for Veterans with stroke receiving care under VA auspices.
  
  
  OBJECTIVE
  This study compares rehabilitation therapy and restorative nursing care among Veterans residing in VA CLCs versus those Veterans in VA-contracted CNHs.
  
  
  METHODS
  Retrospective observational.
  
  
  METHODS
  All Veterans diagnosed with stroke, newly admitted to the CLCs or CNHs during the study period who completed at least 2 Minimum Data Set assessments postadmission.
  
  
  METHODS
  The outcomes were numbers of days for rehabilitation therapy and restorative nursing care received by the Veterans during their stays in CLCs or CNHs as documented in the Minimum Data Set databases.
  
  
  RESULTS
  For rehabilitation therapy, the CLC Veterans had lower user rates (75.2% vs. 76.4%, P=0.078) and fewer observed therapy days (4.9 vs. 6.4, P<0.001) than CNH Veterans. However, the CLC Veterans had higher adjusted odds for therapy (odds ratio=1.16, P=0.033), although they had fewer average therapy days (coefficient=-1.53±0.11, P<0.001). For restorative nursing care, CLC Veterans had higher user rates (33.5% vs. 30.6%, P<0.001), more observed average care days (9.4 vs. 5.9, P<0.001), higher adjusted odds (odds ratio=2.28, P<0.001), and more adjusted days for restorative nursing care (coefficient=5.48±0.37, P<0.001).
  
  
  CONCLUSIONS
  Compared with their counterparts at VA-contracted CNHs, Veterans at VA CLCs had fewer average rehabilitation therapy days (both unadjusted and adjusted), but they were significantly more likely to receive restorative nursing care both before and after risk adjustment.
authors.affiliation: *Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System (NF/SGVHS), Gainesville, FL †Department of Physical Medicine and Rehabilitation, Albany VA Medical Center, Albany Medical College, Albany, NY ‡Department of Veterans Affairs, Physical Medicine and Rehabilitation Service (PM&R), Washington, DC §Malcom Randall VA Medical Center, Gainesville, FL.
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Qinglin
authors.initials: Q
authors.lastname: Pei
authors.forename: Charles T
authors.initials: CT
authors.lastname: Sullivan
authors.forename: Diane C
authors.initials: DC
authors.lastname: Cowper Ripley
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Bidelspach
authors.forename: Xinping
authors.initials: X
authors.lastname: Wang
authors.forename: Nannette
authors.initials: N
authors.lastname: Hoffman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*