Article

OBJECTIVE: To examine geographic and facility variation in cognitive and motor
functional outcomes after postacute inpatient rehabilitation in patients with
stroke. DESIGN: Retrospective cohort design using Centers for Medicare and
Medicaid Services (CMS) claims files. Records from 1209 rehabilitation facilities
in 298 hospital referral regions (HRRs) were examined. Patient records were
analyzed using linear mixed models. Multilevel models were used to calculate the
variation in outcomes attributable to facilities and geographic regions. SETTING:
Inpatient rehabilitation units and facilities. PARTICIPANTS: Patients (N=145,460)
with stroke discharged from inpatient rehabilitation from 2006 through 2009.
INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Cognitive and motor
functional status at discharge measured by items in the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument. RESULTS: Variation
profiles indicated that 19.1% of rehabilitation facilities were significantly
below the mean functional status rating (mean +/- SD, 81.58+/-22.30), with 221
facilities (18.3%) above the mean. Total discharge functional status ratings
varied by 3.57 points across regions. Across facilities, functional status values
varied by 29.2 points, with a 9.1-point difference between the top and bottom
deciles. Variation in discharge motor function attributable to HRR was reduced by
82% after controlling for cluster effects at the facility level. CONCLUSIONS: Our
findings suggest that variation in motor and cognitive function at discharge
after postacute rehabilitation in patients with stroke is accounted for more by
facility than geographic location.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS