Regional variation in stroke rehabilitation outcomes

Reistetter, T. A., Karmarkar, A. M., Graham, J. E., Eschbach, K., Kuo, Y-F., Granger, C. V., ... Ottenbacher, K. J. (2014). Regional variation in stroke rehabilitation outcomes. Archives of Physical Medicine and Rehabilitation, 95(1), 29-38. DOI: 10.1016/j.apmr.2013.07.018

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

DESIGN: Retrospective cohort design.

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

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

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: 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.