Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation
Hong, I., Karmarkar, A., Chan, W., Kuo, Y-F., Mallinson, T., Ottenbacher, K. J., ... Reistetter, T. A. (2018). Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation. American Journal of Physical Medicine & Rehabilitation. DOI: 10.1097/PHM.0000000000000932
OBJECTIVE: To explore variation in acute care use of inpatient (IRF) and skilled nursing (SNF) rehabilitation following ischemic and hemorrhagic stroke.
DESIGN: A secondary analysis of Medicare claims data linked to IRF and SNF assessment files (2013-2014).
RESULTS: The sample included 122,084 stroke patients discharged to IRF or SNF from 3,677 acute hospitals. Of the acute hospitals, 3,649 discharged patients with an ischemic stroke (range 1-402 patients/hospital, median=15) compared to 1,832 acute hospitals that discharged patients with hemorrhagic events (range 1-73 patients/hospital, median=4). The intraclass correlation (ICC) examined variation in discharge settings attributed to acute hospitals (Ischemic ICC=0.318, Hemorrhagic ICC=0.176). Patients >85 years and those with greater numbers of comorbid conditions were more likely to discharge to SNF. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission.
CONCLUSION: This study suggests demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at IRF and SNF settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of IRF and SNF rehabilitation.