title: Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes.
abstract: BACKGROUND
  Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization.
  
  
  OBJECTIVE
  The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care.
  
  
  METHODS
  This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans' inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays.
  
  
  RESULTS
  The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly (p<0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly (p<0.001) less likely to receive restorative nursing care compared with veterans in all other regions, before and after risk adjustment.
  
  
  CONCLUSIONS
  The majority of veterans with stroke received rehabilitation therapy, and about one-third had restorative nursing care during their stay at VA-contracted CNHs. Significant regional variations in weekly days for rehabilitation therapy and restorative nursing care utilization were observed even after adjusting for potential risk factors.
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Qinglin
authors.initials: Q
authors.lastname: Pei
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Sullivan
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Cowper Ripley
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Xinping
authors.initials: X
authors.lastname: Wang
authors.affiliation: Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Bidelspach
authors.affiliation: Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hale-Gallardo
authors.affiliation: Aleda E. Lutz VA Medical Center, Saginaw, MI, USA.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
keywords: nursing home; rehabilitation; restorative care; stroke; utilization