Background
Stroke
is the leading cause for admission to the nearly 1,200 Inpatient
Rehabilitation Facilities (IRFs) nationally in the US. For many
patients, post-acute care is an important component of their
rehabilitation. Several quality measures have been publicly reported for
post-acute care providers, including hospital readmissions. However, to
date none have focused on specific medical conditions, limiting the
usability for patients and quality improvement.
Objective
To
assess hospital readmission rates for Medicare patients receiving
inpatient rehabilitation following stroke and to identify risk factors
in order to evaluate the feasibility of a stroke-specific hospital
readmission measure.
Methods
Observational
study analyzing national Medicare inpatient claims and administrative
data to assess hospital readmissions. Using logistic regression, we
calculated unadjusted and risk-standardized readmission rates, which
adjusted for patient characteristics, including type of stroke and
admission function, to capture stroke severity.
Results
Our
national study included 116,073 fee-for-service Medicare beneficiary
discharged from IRFs in 2013–2014 following stroke from 1,162 IRFs
nationally. The observed hospital readmission rate among IRF patients
following stroke was 11.6% and varied by patients’ admission motor
function. Patients with greater functional dependence had higher
readmission rates on average. Lower admission function, hemorrhagic and
other stroke types (relative to ischemic) were significantly associated
with higher odds of hospital readmission.
Conclusion
Results
suggest it is feasible to assess hospital readmission rates among a
stroke-cohort treated in IRFs. Stroke-focused quality measures would be
useful to patients in selecting a provider and for providers in
evaluating their stroke rehabilitation program outcomes. Secondary
results suggest that admission function (FIM) capture stroke severity, a
limitation with other claims-based stroke measures.
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