The candidate's long term goal is to establish an independently funded research program in the area of health services research and rehabilitation outcomes. The candidate is interested in examining regional variability of rehabilitation outcomes across the continuum of post-acute care. The objectives for his career development plan are to: 1) Gain knowledge in health services and policy research pertaining to rehabilitation outcomes and the utilization of services across post-acute care settings;2) Enhance skills in data management using large databases;3) Expand statistical and analytical skills for examining rehabilitation outcomes through the study of epidemiology, multilevel analysis, and survival analysis;4) Broaden collaboration with other researchers in health services, epidemiology and public health and healthcare policy;5) Develop and demonstrate a track record of publications and presentations on rehabilitation outcomes and health services research;6) Become an expert in regional variation of rehabilitation outcomes and service delivery as evidenced by obtaining external grants (as PI) in that focus area;and 7) Expand knowledge and training in scientific integrity and the responsible conduct of research. The candidate's mentoring team is an interdisciplinary team of externally funded senior investigators who will guide career development activities and assist with the research project. Members include an epidemiologist, rehabilitation/disability specialist, geriatrician, demographer, and biostatistician. The mentorship is integrated with structured course work, seminars, and grant writing workshops. The overall goal of the candidate's research plan is to examine the relationships and interactions between individual, facility and geographic variables on outcomes among the individuals receiving inpatient rehabilitation services after stroke and hip fracture.
The Specific Aims of this project are to: 1) Describe the differences in rehabilitation outcomes (length of stay, functional status, community discharge, re-hospitalization, and mortality) across Hospital Referral Regions (HRR) for older adults who have experienced a stroke or hip fracture;2) Determine how much variation in these outcomes is attributed to the patient, facilities and regions;and 3) Identify patient, facility, and geographic characteristics that independently contribute to variation in these rehabilitation outcomes. The data source will be the Centers for Medicare and Medicaid claims files and the Department of Health and Human Services Area Resource File. The results will establish a framework for improving quality of rehabilitative care in inpatient rehabilitation facilities across hospital referral regions.

Public Health Relevance

Regional variation in rehabilitation is significantly understudied. Examining the influence and interactions between individual, facility, and regional level factors on rehabilitation outcomes will provide novel information related to rehabilitation outcomes. These results will establish a framework for improving quality of rehabilitative care in inpatient rehabilitation facilities by hospital referral regions nationally.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Scientist Development Award - Research & Training (K01)
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Pediatrics Subcommittee (CHHD)
Program Officer
Quatrano, Louis A
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University of Texas Medical Br Galveston
Other Health Professions
Schools of Allied Health Profes
United States
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Díaz-Venegas, Carlos; Reistetter, Timothy A; Wang, Ching-Yi et al. (2016) The progression of disability among older adults in Mexico. Disabil Rehabil 38:2016-27
Reistetter, Timothy A; Kuo, Yong-Fang; Karmarkar, Amol M et al. (2015) Geographic and facility variation in inpatient stroke rehabilitation: multilevel analysis of functional status. Arch Phys Med Rehabil 96:1248-54
Reistetter, Timothy A; Karmarkar, Amol M; Graham, James E et al. (2014) Regional variation in stroke rehabilitation outcomes. Arch Phys Med Rehabil 95:29-38
Wang, Ching-Yi; Graham, James E; Karmarkar, Amol M et al. (2014) FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM R 6:493-7
Karmarkar, Amol M; Graham, James E; Reistetter, Timothy A et al. (2014) Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation. Rehabil Res Pract 2014:961798
Ottenbacher, Kenneth J; Karmarkar, Amol; Graham, James E et al. (2014) Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients. JAMA 311:604-14