Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States

There should be zero variation among services provided. You follow the protocols exactly that lead to 100% recovery. Until we get to this state survivors will be screwed.  If your doctors and hospitals can't see that then you have idiots in charge. And you are paying those idiots.

Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States

Amit Kumar Deepak Adhikari Amol Karmarkar Janet Freburger Pedro Gozalo Vince Mor Linda Resnik

Physical Therapy, Volume 99, Issue 5, May 2019, Pages 494–506, https://doi.org/10.1093/ptj/pzz014

Published:

30 April 2019

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Abstract

Background

Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke.

Objective

The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke.

Design

This was a retrospective, cohort design.

Methods

The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes.

Results

Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99.2] minutes) during an average length of stay of 4.8 [3.5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes.

Limitation

The findings are limited to patients with ischemic stroke.

Conclusion

Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke.

Issue Section:

ORIGINAL RESEARCH

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© 2019 American Physical Therapy Association

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