Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going from Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation

Objective To explore variation in acute care use of inpatient (IRF) and skilled nursing (SNF) rehabilitation following ischemic and hemorrhagic stroke. Design A secondary analysis of Medicare claims data linked to IRF and SNF assessment files (2013-2014). Results The sample included 122,084 stroke patients discharged to IRF or SNF from 3,677 acute hospitals. Of the acute hospitals, 3,649 discharged patients with an ischemic stroke (range 1-402 patients/hospital, median=15) compared to 1,832 acute hospitals that discharged patients with hemorrhagic events (range 1-73 patients/hospital, median=4). The intraclass correlation (ICC) examined variation in discharge settings attributed to acute hospitals (Ischemic ICC=0.318, Hemorrhagic ICC=0.176). Patients >85 years and those with greater numbers of comorbid conditions were more likely to discharge to SNF. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. Conclusion This study suggests demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at IRF and SNF settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of IRF and SNF rehabilitation. Author Disclosures: Conflict of Interest: None declared. Funding: This study was supported with funding from the Agency for Healthcare Quality and Research (R01-HS024711, R24-HS022134), National Institutes of Health (R01-AG033134; R24-HD065702; R01-HD069443; and K01- HD086290), National Institute on Aging OAIC (5P30-AG024832), Institute for Translational Sciences (UL1TR000071). Financial benefits to the authors: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Correspondence: Timothy A. Reistetter, University of Texas Medical Branch, Department of Occupational Therapy, 301 University Blvd, Galveston, Texas 77555-1142. Email: tareiste@utmb.edu. Phone (409)772-944. Fax (409)747-1615 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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