Comparing recovery options for stroke patients / Janet Prvu Bettger, Laine Thomas and Li Liang.

Format:

Book

Author/Creator:

Prvu Bettger, Janet, author.

Thomas, Laine, author.

Liang, Li, author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Final research report

Language:

English

Subjects (All):

Outcome assessment (Medical care).

Physical Description:

1 online resource.

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: The negative health impact of stroke can be drastically reduced by effective treatment options early poststroke. Because patients receive only a 4-day hospital length of stay, most care is provided after hospital discharge. However, evidence is not available to guide stroke survivors, caregivers, and health care professionals to make an informed decision at hospital discharge about postacute service referral. OBJECTIVES: The study sought to (1) describe stroke survivors' postacute service use and identify the person- and systems-level factors associated with the use of rehabilitation services following hospital discharge; (2) among stroke survivors discharged to short-term inpatient rehabilitation, examine the comparative effectiveness of high-intensity (in inpatient rehabilitation facilities [IRFs]) vs low-intensity (in skilled nursing facilities [SNFs]) care on 3- and 12-month outcomes; and (3) among stroke survivors discharged home from the hospital, examine early follow-up with community-based providers. METHODS: For this retrospective observational study of patients aged 65 years and older, we linked national registry, longitudinal patient follow-up, and administrative claims data to identify predictors of health service use and to assess outcomes following hospitalization for an ischemic stroke. Among patients discharged from the hospital to continue care in short-term inpatient postacute settings, we conducted a comparative effectiveness evaluation of IRF compared with SNF using instrumental variables and inverse probability weighted estimation propensity score-based methods. Among patients discharged directly home from the hospital, we examined the association of early follow-up and rehospitalization, death, and home time (primary outcome) using multivariable analysis. RESULTS: More than half of 162 432 stroke patients treated at 1192 hospitals experienced 3 or more care transitions after hospital discharge, and the number of days alive and living in the community (home time) varied by many factors. Nearly half of all stroke patients (43.7%) are discharged directly home from the hospital only 4 days after their stroke and 47.2% transition to another inpatient postacute facility. The likelihood of receiving short-term inpatient postacute care at IRFs vs SNFs varied nearly 3 times across hospitals (adjusted median odds ratio for receipt of IRF care vs SNF = 2.87; 95% CI, 2.68-3.11), even among patients with the same set of covariates, suggesting substantial variation even after accounting for all observed characteristics. Comparing outcomes for patients who received IRF or SNF care identified a higher likelihood of better outcomes for patients who received IRF care, particularly within 90 days of hospital discharge. IRF patients had better 12-month home time (primary outcome) and survival and were less likely to be rehospitalized or institutionalized in a nursing home. Care for patients discharged home from the hospital was fragmented and, in some cases, delayed. Only 13.68% received home health services after hospital discharge and 6.41% received outpatient rehabilitation. Stroke survivors shared with us that the latter was dependent on referral from a community-based provider. However, among patients discharged home, the average number of days to first medical follow-up was 27 days. Physician follow-up poststroke was more common with internal medicine or primary care (50.3% and 70.1%) and cardiology (53.3%) than neurology (42.4%). The median number of days to first visit with neurology was 35 days (interquartile range [IQR] = 18-87 days), whereas first visit with internal medicine was 18 days (IQR, 7-93 days) and primary care was 22 days (IQR, 7-159 days) from hospital discharge. The hospital-level rate of follow-up within 7 days of hospital discharge was 39%. CONCLUSIONS: The research conducted in this funded project strengthened the evidence base for the receipt of short-term inpatient rehabilitation and early follow-up with physicians after hospital discharge and revealed important variations in care for future research.

Notes:

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