THE COMPARATIVE EFFECTIVENESS OF INPATIENT VERSUS SKILLED NURSING FACILITY REHABILITATION USING LINKED ACUTE STROKE REGISTRY DATA.

Abstract

To examine the comparative effectiveness of rehabilitation at inpatient rehabilitation facilities (IRFs) versus skilled nursing facilities (SNFs) on home time- a proxy of functional recovery among acute stroke patients. A retrospective comparative effectiveness cohort of hospitalized acute stroke (ICD-10 I61-I63) cases identified by the Michigan Stroke Registry and probabilistically linked to Medicare fee for service (FFS) data. We quantified the comparative effectiveness of IRF vs SNF using inverse probability treatment weighted (IPTW) multivariable linear models. IRF and SNF admissions from 31 registry hospitals between 2016-2020. Fee-for-service (FFS) Medicare patients with acute stroke. Not applicable. 90-day and 1-year home time (number of days alive and outside of inpatient care) calculated at two different starting points: from the time of discharge from acute hospital care (traditional home time) or the time of discharge from IRF or SNF care (referred to as amended home time). We identified 5,943 hospitalized Medicare FFS beneficiaries discharged to IRF (n=2,995) or SNF (n=2,948). After IPTW adjustment, mean traditional home time for IRF patients was 11.1 days (95% CI: 9.5 - 12.57) longer at 90 days, and 46.3 days (95% CI: 39.8 - 52.9) longer at one year, compared to SNF patients. However, when amended home time was used the mean difference in 90-day home time disappeared (0.5 days; 95% CI: -1.1 - 2.1) but remained significant at one year (35.7 days; 95% CI: 29.1 - 42.2). IRF care was associated with longer traditional home time both at 90 and one year. However, amended home time showed that the difference at 90 days was explained by the longer length of stay at SNF facilities. Future studies should avoid using traditional home time as a means of comparing patient outcomes between IRF and SNF settings.