Stroke is the leading cause of disability and the third leading cause of death in the United States. After suffering a stroke, the pattern of acute and postacute rehabilitation is often determined by the physician with consideration of the patient's clinical status and the health care delivery system. As a result, the types of acute and postacute services received by stroke patients may vary substantially. This study focuses on the movement of patients from the acute hospital to postacute (skilled nursing facility (SNF) and/or freestanding rehabilitation hospital) settings.
The specific aims are to: (1) compare and contrast the demographic, clinical, and organizational characteristics of stroke patients who receive six different patterns of rehabilitation use: acute hospital rehabilitation only; acute hospital and SNF rehabilitation; acute hospital and freestanding rehabilitation hospital care; SNF rehabilitation only; freestanding rehabilitation hospital care only; and no rehabilitation; (2) to compare and contrast facility length of stay by rehabilitation use pattern and identify characteristics associated with length of stay; (3) to compare and contrast total episode days of care by rehabilitation use pattern and identify characteristics associated with total episode days of care; and (4) to compare and contrast discharge destination by rehabilitation use pattern and identify characteristics associated with discharge destination. To accomplish these aims, we will conduct a cross-sectional, secondary analysis of Fiscal Year 1995 administrative data obtained from the Health Care Financing Administration. Several datasets will be merged to develop an analytical file that contains demographic, clinical, facility, and resource use variables. The specific data sets to be merged are: the Medicare Provider Analysis and Review File, Provider Specific File, Hospital Cost Report Information System Minimum Data Set, and SNF Minimum Data Set. Data will be analyzed using multivariate techniques. The findings of this study will contribute towards our current knowledge of how patterns of rehabilitation utilization throughout an episode of care influence clinical outcomes of care. The findings have implications for the development of an integrated payment system for postacute services.
