Emulating 3 clinical trials that compare stroke rehabilitation at inpatient rehabilitation facilities with skilled nursing facilities

FYI, for when you doctor is working on discharging you. The ONLY question for your doctor to answer is: 'Which facility will get me 100% recovered?' And keep asking that question until they finally acknowledge they don't know EXACTLY how to get you 100% recovered, then you ask for all payments for your care be refunded to you, pay for performance should be standard practice in stroke.

 Emulating 3 clinical trials that compare stroke rehabilitation at inpatient rehabilitation facilities with skilled nursing facilities

Archives of Physical Medicine and Rehabilitation , Volume 103(7) , Pgs. 1311-1319.

NARIC Accession Number: J89440.  What's this?
ISSN: 0003-9993.
Author(s): Simmonds, Kent P.; Burke, James; Kozlowski, Allan J.; Andary, Michael; Luo, Zhehui; Reeves, Mathew J..
Publication Year: 2022.
Number of Pages: 9.

Abstract: 

 Study emulated 3 trials where patient-level outcomes after stroke rehabilitation at inpatient rehabilitation facilities (IRFs) were compared with skilled nursing facilities (SNFs) to inform the design of a potential future randomized controlled trial (RCT). The 3 trials differed because facilities from rehabilitation networks with different case volumes were compared. Rehabilitation network case volumes were based on the number of patients with stroke that each hospital discharged to each specific IRF or SNF. Trial 1 included 60,529 patients from all networks, trial 2 included 34,444 patients from networks with medium and large case volumes (i.e., ≥5 patients), and trial 3 included 19,161 patients from networks with large case volumes (i.e., ≥10 patients). The E values were calculated to estimate the minimum strength that an unmeasured confounder would need to be to nullify the results. Outcome measures included one-year successful community discharge (home for >30 consecutive days) and all-cause mortality. Overall, 29,500; 15,156; and 7,450 patients were matched for trials 1, 2, and 3. For 1-year successful community discharge, absolute risk differences for IRF patients were 0.21, 0.17, and 0.12 in trials 1, 2, and 3, respectively. For 1-year all-cause mortality, corresponding risk differences were −0.11, −0.11, and −0.08. The E values indicated that a moderately sized unmeasured confounder, with a relative risk of 1.6 to 2.0 would nullify differences in successful community discharge. IRF patients had superior outcomes, but differences were attenuated when IRFs and SNFs from larger rehabilitation networks were compared. The vulnerability of the findings to unmeasured confounding supports the need for an RCT.
Descriptor Terms: HEALTH CARE, NURSING HOMES, OUTCOMES, REHABILITATION FACILITIES, REHABILITATION SERVICES, SERVICE DELIVERY, STROKE.


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Citation: Simmonds, Kent P., Burke, James, Kozlowski, Allan J., Andary, Michael, Luo, Zhehui, Reeves, Mathew J.. (2022). Emulating 3 clinical trials that compare stroke rehabilitation at inpatient rehabilitation facilities with skilled nursing facilities.  Archives of Physical Medicine and Rehabilitation , 103(7), Pgs. 1311-1319. Retrieved 8/22/2022, from REHABDATA database.