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Estimating the Impact of Hospital-Level Variation on the Use of Inpatient Rehabilitation Facilities Versus Skilled Nursing Facilities on Individual Patients With Stroke.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2024 Sep; Vol. 17 (9), pp. e010636. Date of Electronic Publication: 2024 Jul 18. - Publication Year :
- 2024
-
Abstract
- Background: There is substantial hospital-level variation in the use of Inpatient Rehabilitation Facilities (IRFs) versus Skilled Nursing Facilities (SNFs) among patients with stroke, which is poorly understood. Our objective was to quantify the net effect of the admitting hospital on the probability of receiving IRF or SNF care for individual patients with stroke.<br />Methods: Using Medicare claims data (2011-2013), a cohort of patients with acute stroke discharged to an IRF or SNF was identified. We generated 2 multivariable logistic regression models. Model 1 predicted IRF admission (versus SNF) using only patient-level factors, whereas model 2 added a hospital random effect term to quantify the hospital effect. The statistical significance and direction of the random effect terms were used to categorize hospitals as being either IRF-favoring, SNF-favoring, or neutral with respect to their discharge patterns. The hospital's impact on individual patient's probability of IRF discharge was estimated by taking the change in individual predicted probabilities (change in individual predicted probability) between the 2 models. Hospital-level effects were categorized as small (<10%), moderate (10%-19%), or large (≥20%) depending on change in individual predicted probability.<br />Results: The cohort included 135 415 patients (average age, 81.5 [SD=8.0] years, 61% female, 91% ischemic stroke) who were discharged from 1816 acute care hospitals to IRFs (n=66 548) or SNFs (n=68 867). Half of hospitals were classified as being either IRF-favoring (n=461, 25.4%) or SNF-favoring (n=485, 26.7%) with the remainder (n=870, 47.9%) considered neutral. Overall, just over half (n=73 428) of patients were treated at hospitals that had moderate or large independent effects on discharge settings. Hospital effects for neutral hospitals were small (ie, change in individual predicted probability <10%) for most patients (72.5%). However, hospital effects were moderate or large for 78.8% and 84.6% of patients treated at IRF- or SNF-favoring hospitals, respectively.<br />Conclusions: For most patients with stroke, the admitting hospital meaningfully changed the type of rehabilitation care that they received.<br />Competing Interests: None.
- Subjects :
- Humans
Female
Male
United States epidemiology
Aged
Aged, 80 and over
Inpatients
Databases, Factual
Time Factors
Healthcare Disparities
Administrative Claims, Healthcare
Treatment Outcome
Retrospective Studies
Risk Factors
Skilled Nursing Facilities
Stroke Rehabilitation
Medicare
Stroke diagnosis
Stroke therapy
Patient Discharge
Rehabilitation Centers
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 17
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 39022826
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.123.010636