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Geographic and Facility Variation in Inpatient Stroke Rehabilitation: Multilevel Analysis of Functional Status
- Source :
- Archives of Physical Medicine and Rehabilitation. 96:1248-1254
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Referral
Intraclass correlation
medicine.medical_treatment
Physical Therapy, Sports Therapy and Rehabilitation
Medicare
Disease cluster
Rehabilitation Centers
Article
Insurance Claim Review
Cognition
Physical medicine and rehabilitation
Activities of Daily Living
medicine
Humans
Stroke
Aged
Retrospective Studies
Aged, 80 and over
Inpatients
Rehabilitation
business.industry
Multilevel model
Stroke Rehabilitation
Retrospective cohort study
Recovery of Function
Length of Stay
medicine.disease
United States
Multilevel Analysis
Physical therapy
Female
business
Medicaid
Subjects
Details
- ISSN :
- 00039993
- Volume :
- 96
- Database :
- OpenAIRE
- Journal :
- Archives of Physical Medicine and Rehabilitation
- Accession number :
- edsair.doi.dedup.....d06442c2ee763ddbd073950b4ffffdb8