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Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities.

ABSTRACT: Importance:Health care reform legislation and Medicare plans for unified payment for postacute care highlight the need for research examining service delivery and outcomes. Objective:To compare functional outcomes in patients with stroke after postacute care in inpatient rehabilitation facilities (IRF) vs skilled nursing facilities (SNF). Design, Setting, and Participants:This cohort study included patients with stroke who were discharged from acute care hospitals to IRF or SNF from January 1, 2013, to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. Data analyses were conducted from January 17, 2017, through April 25, 2019. Exposures:Inpatient rehabilitation received in IRFs vs SNFs. Main Outcomes and Measures:Changes in mobility and self-care measures during an IRF or SNF stay were compared using multivariate analyses, inverse probability weighting with propensity score, and instrumental variable analyses. Mortality between 30 and 365 days after discharge was included as a control outcome as an indicator for unmeasured confounders. Results:Among 99?185 patients who experienced a stroke between January 1, 2013, and November 30, 2014, 66?082 patients (66.6%) were admitted to IRFs and 33?103 patients (33.4%) were admitted to SNFs. A higher proportion of women were admitted to SNFs (21?466 [64.8%] women) than IRFs (36?462 [55.2%] women) (P?

SUBMITTER: Hong I

PROVIDER: S-EPMC6902754 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities.

Hong Ickpyo I Goodwin James S JS Reistetter Timothy A TA Kuo Yong-Fang YF Mallinson Trudy T Karmarkar Amol A Lin Yu-Li YL Ottenbacher Kenneth J KJ

JAMA network open 20191202 12

<h4>Importance</h4>Health care reform legislation and Medicare plans for unified payment for postacute care highlight the need for research examining service delivery and outcomes.<h4>Objective</h4>To compare functional outcomes in patients with stroke after postacute care in inpatient rehabilitation facilities (IRF) vs skilled nursing facilities (SNF).<h4>Design, setting, and participants</h4>This cohort study included patients with stroke who were discharged from acute care hospitals to IRF or ...[more]

PMID: 31800069

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Project description:IntroductionPost-dialysis recovery time (DRT) has an important relationship to quality of life and survival, as identified in studies of ESRD patients on conventional dialysis. ESRD patients are often discharged from hospitals to skilled nursing facilities (SNFs) where on-site treatment using home hemodialysis technology is increasingly offered, but nothing is known about DRT in this patient population.MethodsFrom November 4, 2019 to June 11, 2021, within a dialysis organization providing service across 12 states and 154 SNFs, patients receiving in-SNF, more frequent dialysis (MFD) (modeled to deliver 14 treatment hours minimum per week and stdKt/V ≥2.0) were asked to describe their post-dialysis recovery time following their previous treatment, within predefined categoric choices: 0-½, ½-1, 1-2, 2-4, 4-8, 8-12 h, by next morning, or not even by next morning. Patients reporting DRT following at least one full-week treatment opportunity were included in a mixed model logistic regression of rapid recovery (DRT ≤2 h).FindingsTwo thousand three hundred and nine patients met the statistical modeling inclusion criteria, providing DRT on 108,876 dialysis sessions, while receiving mean (SD) 4.3 (0.96) weekly dialysis treatments. 2118 (92%) reported DRT ≤2 h. Results appeared biologically plausible, as lower odds of rapid DRT were observed for patients who were older, missed their previous treatment, or experienced intradialytic hypotension. Greater odds of rapid DRT were observed in patients receiving five dialyses in the previous week or having 160-179 mmHg pre-hemodialysis systolic blood pressure. Rapid recovery was associated with reduced mortality or hospitalization.DiscussionSNF dialysis patients receiving 5x per week MFD report rapid recovery time ≤2 h in 92% of dialyses despite advanced age, frailty, and comorbidities. Future studies will assess the practical ramifications of rapid DRT perception/experience on nursing home rehabilitation programs, which could impact patient health beyond the nursing home stay.

Dataset Information

Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities.

Publications

Comparison of Functional Status Improvements Among Patients With Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities.

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