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Jones Berkeley SB, Johnson AM, Mormer ER, Ressel K, Pastva AM, Wen F, Patterson CG, Duncan PW, Bushnell CD, Zhang S, Freburger JK. Referral to Community-Based Rehabilitation Following Acute Stroke: Findings From the COMPASS Pragmatic Trial. Circ Cardiovasc Qual Outcomes 2024; 17:e010026. [PMID: 38189125 PMCID: PMC10997162 DOI: 10.1161/circoutcomes.123.010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/13/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Few studies on care transitions following acute stroke have evaluated whether referral to community-based rehabilitation occurred as part of discharge planning. Our objectives were to describe the extent to which patients discharged home were referred to community-based rehabilitation and identify the patient, hospital, and community-level predictors of referral. METHODS We examined data from 40 North Carolina hospitals that participated in the COMPASS (Comprehensive Post-Acute Stroke Services) cluster-randomized trial. Participants included adults discharged home following stroke or transient ischemic attack (N=10 702). In this observational analysis, COMPASS data were supplemented with hospital-level and county-level data from various sources. The primary outcome was referral to community-based rehabilitation (physical, occupational, or speech therapy) at discharge. Predictor variables included patient (demographic, stroke-related, medical history), hospital (structure, process), and community (therapist supply) measures. We used generalized linear mixed models with a hospital random effect and hierarchical backward model selection procedures to identify predictors of therapy referral. RESULTS Approximately, one-third (36%) of stroke survivors (mean age, 66.8 [SD, 14.0] years; 49% female, 72% White race) were referred to community-based rehabilitation. Rates of referral to physical, occupational, and speech therapists were 31%, 18%, and 10%, respectively. Referral rates by hospital ranged from 3% to 78% with a median of 35%. Patient-level predictors included higher stroke severity, presence of medical comorbidities, and older age. Female sex (odds ratio, 1.24 [95% CI, 1.12-1.38]), non-White race (2.20 [2.01-2.44]), and having Medicare insurance (1.12 [1.02-1.23]) were also predictors of referral. Referral was higher for patients living in counties with greater physical therapist supply. Much of the variation in referral across hospitals remained unexplained. CONCLUSIONS One-third of stroke survivors were referred to community-based rehabilitation. Patient-level factors predominated as predictors. Variation across hospitals was notable and presents an opportunity for further evaluation and possible targets for improved poststroke rehabilitative care. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02588664.
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Affiliation(s)
- Sara B Jones Berkeley
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Anna M Johnson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Elizabeth R Mormer
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
| | - Kristin Ressel
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
| | - Amy M Pastva
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division and Center for the Study of Aging and Human Development, Duke University School of Medicine (A.M.P.)
| | - Fang Wen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Charity G Patterson
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
- Department of Neurology, Wake Forest School of Medicine (P.W.D., C.D.B.)
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine (P.W.D., C.D.B.)
| | | | - Shuqi Zhang
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health (S.B.J.B., A.M.J., F.W., S.Z.)
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, School of Health and Rehabilitation Sciences (E.R.M., K.R., C.G.P., J.K.F.)
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Stamm B, Royan R, Trifan G, Alvarado-Dyer R, Velez FGS, Taylor W, Pinna P, Reish NJ, Vargas A, Goldenberg FD, Schneck MJ, Biller J, Testai F, Caprio FZ, Chou SH, Gorelick PB, Liotta EM, Batra A. Household income is associated with functional outcomes in a multi-institutional cohort of patients with ischemic stroke and COVID-19. J Stroke Cerebrovasc Dis 2023; 32:107059. [PMID: 36842351 PMCID: PMC9939399 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has heightened awareness of health disparities associated with socioeconomic status (SES) across the United States. We examined whether household income is associated with functional outcomes after stroke and COVID-19. MATERIALS AND METHODS This was a multi-institutional, retrospective cohort study of consecutively hospitalized patients with SARS-CoV-2 and radiographically confirmed stroke presenting from March through November 2020 to any of five comprehensive stroke centers in metropolitan Chicago, Illinois, USA. Zip-code-derived household income was dichotomized at the Chicago median. Logistic regression was used to examine the relationship between household income and good functional outcome (modified Rankin Scale 0-3 at discharge, after ischemic stroke). RESULTS Across five hospitals, 159 patients were included. Black patients comprised 48.1%, White patients 38.6%, and Hispanic patients 27.7%. Median household income was $46,938 [IQR: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5) and hemorrhagic stroke in 37 (23.7%). When controlling for age, sex, severe COVID-19, and NIHSS, patients with ischemic stroke and household income above the Chicago median were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016). Race/ethnicity were not included in final adjusted models given collinearity with income. CONCLUSIONS In this multi-institutional study of hospitalized patients with stroke, those residing in higher SES zip codes were more likely to have better functional outcomes, despite controlling for stroke severity and COVID-19 severity. This suggests that area-based SES factors may play a role in outcomes from stroke and COVID-19.
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Affiliation(s)
- Brian Stamm
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Regina Royan
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabriela Trifan
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Chicago, IL
| | | | - Faddi G. Saleh Velez
- Department of Neurology, University of Chicago, Chicago, IL,Department of Neurology, The University of Oklahoma College of Medicine, Oklahoma City, OK
| | - William Taylor
- Ascension Medical Group, Milwaukee, WI,Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - Pranusha Pinna
- Department of Neurology, Rush University Medical Center, Chicago, IL,National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD
| | - Nicholas J. Reish
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro Vargas
- Department of Neurology, Rush University Medical Center, Chicago, IL
| | | | - Michael J Schneck
- Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - José Biller
- Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - Fernando Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Fan Z. Caprio
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sherry H. Chou
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip B. Gorelick
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric M. Liotta
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Association of material deprivation with discharge location and length of stay after inpatient stroke rehabilitation in Ontario: a retrospective, population-based cohort study. CMAJ Open 2022; 10:E50-E55. [PMID: 35078823 PMCID: PMC8920538 DOI: 10.9778/cmajo.20200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low socioeconomic status is associated with increased risk of stroke and worse poststroke functional status. The aim of this study was to determine whether socioeconomic status, as measured by material deprivation, is associated with direct discharge to long-term care or length of stay after inpatient stroke rehabilitation. METHODS We performed a retrospective, population-based cohort study of people admitted to inpatient rehabilitation in Ontario, Canada, after stroke. Community-dwelling adults (aged 19-100 yr) discharged from acute care with a most responsible diagnosis of stroke between Sept. 1, 2012, and Aug. 31, 2017, and subsequently admitted to an inpatient rehabilitation bed were included. We used a multivariable logistic regression model to examine the association between material deprivation quintile (from the Ontario Marginalization Index) and discharge to long-term care, and a multivariable negative binomial regression model to examine the association between material deprivation quintile and rehabilitation length of stay. RESULTS A total of 18 736 people were included. There was no association between material deprivation and direct discharge to long-term care (most v. least deprived: odds ratio [OR] 1.07, 95% confidence interval [CI] 0.89-1.28); however, people living in the most deprived areas had a mean length of stay 1.7 days longer than that of people in the least deprived areas (p = 0.004). This difference was not significant after adjustment for other baseline differences (relative change in mean 1.02, 95% CI 0.99-1.04). INTERPRETATION People admitted to inpatient stroke rehabilitation in Ontario had similar discharge destinations and lengths of stay regardless of their socioeconomic status. In future studies, investigators should consider further examining the associations of material deprivation with upstream factors as well as potential mitigation strategies.
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Affiliation(s)
- Shannon L MacDonald
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont.
| | - Ruth E Hall
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Chaim M Bell
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Shawna Cronin
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Susan B Jaglal
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
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Freburger JK, Pastva AM, Coleman SW, Peter KM, Kucharska-Newton AM, Johnson AM, Psioda MA, Duncan PW, Bushnell CD, Rosamond WD, Jones SB. Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries s Discharged Home following a Stroke: Findings from the COMPASS Trial. Arch Phys Med Rehabil 2021; 103:882-890.e2. [PMID: 34740596 DOI: 10.1016/j.apmr.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To examine the effect of a comprehensive transitional care model on the utilization of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke. DESIGN Cluster randomized pragmatic trial Setting: 41 acute care hospitals in North Carolina. PARTICIPANTS 2,262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (standard deviation [SD]) age of 74.9 (10.2) years and a mean (SD) NIH stroke scale score of 2.3 (3.7). INTERVENTION Comprehensive transitional care model (COMPASS-TC) which consisted of a 2-day follow-up phone call from the post-acute care coordinator (PAC) and 14-day in-person visit with the PAC and advanced practice provider. MAIN OUTCOME MEASURES Time to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission. RESULTS Only 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (HR=1.20 [0.95 - 1.52]) compared to usual care. This estimate was robust to additional covariate adjustment (HR=1.23 [0.93-1.64]). Both clinical and non-clinical factors (i.e., insurance, geography) were predictors of SNF/IRF use. CONCLUSIONS COMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care.
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Affiliation(s)
- Janet K Freburger
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, Suite 210, 100 Technology Dr, Pittsburgh, PA 15219-3130.
| | - Amy M Pastva
- Duke University School of Medicine, DUMC Box 104002, 311 Trent Drive, Durham, NC, 27710
| | - Sylvia W Coleman
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157
| | - Kennedy M Peter
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599; Department of Epidemiology, College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY, 40536
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599
| | - Matthew A Psioda
- Department of Biostatistics, Gillings School of Global Public Health, 135 University of North Carolina at Chapel Hill, Dauer Dr, Chapel Hill, NC 27599
| | - Pamela W Duncan
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599
| | - Sara B Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599
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Exploring discharge destination following severe stroke. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.Aim:The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.Method:A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.Results:The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.Conclusion:These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.
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Wasserman A, Thiessen M, Pooyania S. Factors associated with community versus personal care home discharges after inpatient stroke rehabilitation: the need for a pre-admission predictive model. Top Stroke Rehabil 2019; 27:173-180. [DOI: 10.1080/10749357.2019.1682369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alexander Wasserman
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Michelle Thiessen
- Department of Statistics and Epidemiology, University of Manitoba, Winnipeg, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
BACKGROUND Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care. METHODS A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories. RESULTS Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures. CONCLUSIONS There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.
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Jaffe KM, Jimenez N. Disparity in rehabilitation: another inconvenient truth. Arch Phys Med Rehabil 2015; 96:1371-4. [PMID: 25958194 PMCID: PMC4871110 DOI: 10.1016/j.apmr.2015.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Kenneth M Jaffe
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Department of Neurological Surgery, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Nathalia Jimenez
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
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Nguyen VQ, PrvuBettger J, Guerrier T, Hirsch MA, Thomas JG, Pugh TM, Rhoads CF. Factors Associated With Discharge to Home Versus Discharge to Institutional Care After Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2015; 96:1297-303. [DOI: 10.1016/j.apmr.2015.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/04/2015] [Accepted: 03/14/2015] [Indexed: 11/27/2022]
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Tseng HP, Lin FJ, Chen PT, Mou CH, Lee SP, Chang CY, Chen AC, Liu CH, Yeh CH, Tsai SY, Hsiao YJ, Lin CH, Hsu SP, Yu SC, Hsu CY, Sung FC. Derivation and validation of a discharge disposition predicting model after acute stroke. J Stroke Cerebrovasc Dis 2015; 24:1179-86. [PMID: 25847306 DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/05/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. METHODS We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. RESULTS Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). CONCLUSIONS The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.
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Affiliation(s)
- Hung-Pin Tseng
- Department of Neurology, Lotung Pohai Hospital, Lotung, Ilan, Taiwan
| | - Feng-Jenq Lin
- Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan
| | - Pi-Tzu Chen
- Department of Applied Economics and Management, National Ilan University, Ilan, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Chun-Yuan Chang
- Department of Neurology, Min Sheng General Hospital, Taoyuan, Taiwan
| | - An-Chih Chen
- Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsiang Liu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsin Yeh
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Song-Yen Tsai
- Department of Neurology, Changhua Christian Hospital Yunlin Branch, Yunlin, Taiwan
| | - Yu-Jen Hsiao
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Ching-Huang Lin
- Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Yu
- Department of Neurology, Kuang Tien General Hospital Dajia Division, Taichung, Taiwan
| | - Chung-Y Hsu
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
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iScore for predicting institutional care after ischemic stroke: a population-based study. J Stroke Cerebrovasc Dis 2015; 24:694-8. [PMID: 25601174 DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/31/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We assessed whether the iScore could predict the need for poststroke institutional care. METHODS Patients with acute ischemic stroke living in Dijon, France, were recorded between 2006 and 2011, using a population-based stroke registry. The iScore was calculated for each patient. A logistic regression model was used to assess the performance of the iScore for predicting the need for placement in a care institution. The discrimination and calibration of the model were assessed using the c statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS Of the 1199 patients recorded, 124 were excluded because of early death and 95 because of missing for variables included in the iScore. Of the remaining 980 patients, 522 (53.3%) returned home and 458 (46.7%) required placement in a care institution. The median iScore was 123 (interquartile range, 97-148), and the proportion of patients who required placement in a care institution increased with each quintile of risk score. The discrimination of the model was good with a c statistic of .75 (95% confidence interval, .72-.78), as was calibration (P = .35). CONCLUSIONS The iScore could be useful for predicting the need for placement in a care institution in ischemic stroke patients. Further studies are required to confirm this finding.
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Gregory P, Edwards L, Faurot K, Williams SW, Felix AC. Patient Preferences for Stroke Rehabilitation. Top Stroke Rehabil 2015; 17:394-400. [DOI: 10.1310/tsr1705-394] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Van der Cruyssen K, Vereeck L, Saeys W, Remmen R. Prognostic factors for discharge destination after acute stroke: a comprehensive literature review. Disabil Rehabil 2014; 37:1214-27. [DOI: 10.3109/09638288.2014.961655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kurichi JE, Xie D, Bates BE, Ripley DC, Vogel WB, Kwong P, Stineman MG. Factors associated with home discharge among veterans with stroke. Arch Phys Med Rehabil 2014; 95:1277-1282.e3. [PMID: 24685385 DOI: 10.1016/j.apmr.2014.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/03/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs. DESIGN Retrospective observational study. SETTING Veterans Affairs facilities nationwide. PARTICIPANTS Veterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N=12,565). INTERVENTION Not applicable. MAIN OUTCOME MEASURE Discharge location after hospitalization. RESULTS There were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.11-1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=.04; 95% CI=.03-.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR=.61; 95% CI=.50-.74) or other central nervous system hemorrhage (OR=.78; 95% CI=.63-.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR=1.36; 95% CI=1.07-1.73) were more likely to return home. Evidence of congestive heart failure (OR=.85; 95% CI=.76-.95), fluid and electrolyte disorders (OR=.86; 95% CI=.77-.96), internal organ procedures and diagnostics (OR=.87; 95% CI=.78-.97), and serious nutritional compromise (OR=.49; 95% CI=.40-.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge. CONCLUSIONS We found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.
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Affiliation(s)
- Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Barbara E Bates
- Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY
| | - Diane Cowper Ripley
- Department of Veterans Affairs Health Services Research and Development/Rehabilitation Research and Development Rehabilitation Outcomes Research Center Research Enhancement Award Program North Florida/South Georgia Veterans Health System, Gainesville, FL; Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL
| | - W Bruce Vogel
- Veterans Affairs Medical Center, Gainesville, FL; Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Pui Kwong
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Margaret G Stineman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA
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Bates BE, Kwong PL, Xie D, Valimahomed A, Ripley DC, Kurichi JE, Stineman MG. Factors Influencing Receipt of Early Rehabilitation After Stroke. Arch Phys Med Rehabil 2013; 94:2349-2356. [PMID: 23924439 DOI: 10.1016/j.apmr.2013.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Groth GN, Farrar-Edwards D. Patterns of research utilization among Certified Hand Therapists. J Hand Ther 2013; 26:245-53; quiz 254. [PMID: 23391828 PMCID: PMC4246010 DOI: 10.1016/j.jht.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/15/2012] [Accepted: 12/28/2012] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Mixed methods, cross-sectional. INTRODUCTION Nearly 30% of Certified Hand Therapists rarely or never use research findings when treating carpal tunnel syndrome. PURPOSE OF THE STUDY To identify groups of CHTs with common research utilization patterns. METHODS National randomized mail survey of 600 CHTs (n = 308, RR = 55%). Latent class and thematic analysis of eight questions assessing research use and beliefs. RESULTS Four groups of CHT research users were identified: Analytic (n = 135, 45%); Skeptic (n = 65, 22%); Pragmatic (n = 53, 18%); and Traditional (n = 46, 15%). Highest research use was reported among Analytics and Pragmatics although Skeptics willingly relied on research evidence when it contradicted other sources of knowledge. Age, not experience or population density, was a significant covariate of group membership. CONCLUSIONS Empowering CHTs to use research findings by increased understanding of their group membership, and understanding others' groups, may increase progress toward evidence-based practice.
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Affiliation(s)
- Gail N. Groth
- Department of Orthopedics & Hands, UW Hospitals and Clinics, Madison, WI, USA, Corresponding author. 1406 Beacon Drive, Watertown, WI 53098, USA. Tel.: +1 920 253 6745; fax: +1 608 262 1639. (G.N. Groth)
| | - Dorothy Farrar-Edwards
- Program in Occupational Therapy, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
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Béjot Y, Troisgros O, Gremeaux V, Lucas B, Jacquin A, Khoumri C, Aboa-Eboulé C, Benaïm C, Casillas JM, Giroud M. Poststroke Disposition and Associated Factors in a Population-Based Study. Stroke 2012; 43:2071-7. [DOI: 10.1161/strokeaha.112.658724] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The organization of poststroke care will be a major challenge in coming years. We aimed to assess hospital disposition after stroke and its associated factors in clinical practice.
Methods—
All cases of stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, and prestroke treatments were recorded. Admission stroke severity was assessed using the National Institutes of Health Stroke Scale score. At discharge, we collected dementia, disability using the modified Rankin Scale, length of stay, and hospital disposition (home, rehabilitation, convalescent home, and nursing home). Multivariate analyses were performed using logistic regression models to identify associated factors of postdischarge disposition.
Results—
Of the patients with 1069 stroke included, 913 survived acute care. Among them, 433 (47.4%) returned home, whereas 206 (22.6%) were discharged to rehabilitation, 134 (14.7%) were admitted to a convalescent home, and 140 (15.3%) to a nursing home. Old patients, those under anticoagulants before stroke, those with severe stroke on admission, severe disability at discharge, dementia, or prolonged length of stay were less likely to return home. Moreover, advanced age, severe initial stroke, severe disability at discharge, and dementia were associated with admission to convalescent and nursing homes rather than rehabilitation centers.
Conclusion—
This population-based study demonstrated that postdischarge destinations are associated with several factors. Our findings may be useful to establish health policy concerning the organization of poststroke care.
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Affiliation(s)
- Yannick Béjot
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Odile Troisgros
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Vincent Gremeaux
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Brigitte Lucas
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Agnès Jacquin
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Catia Khoumri
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Corine Aboa-Eboulé
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Charles Benaïm
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Jean-Marie Casillas
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Maurice Giroud
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
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Hakkennes SJ, Brock K, Hill KD. Selection for Inpatient Rehabilitation After Acute Stroke: A Systematic Review of the Literature. Arch Phys Med Rehabil 2011; 92:2057-70. [DOI: 10.1016/j.apmr.2011.07.189] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/03/2011] [Accepted: 07/12/2011] [Indexed: 01/04/2023]
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Freburger JK, Holmes GM, Ku LJE, Cutchin MP, Heatwole-Shank K, Edwards LJ. Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases. Arch Phys Med Rehabil 2011; 92:1220-9. [PMID: 21807141 PMCID: PMC4332528 DOI: 10.1016/j.apmr.2011.03.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/23/2011] [Accepted: 03/20/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the extent to which sociodemographic and geographic disparities exist in the use of postacute rehabilitation care (PARC) after stroke. DESIGN Cross-sectional analysis of data for 2 years (2005-2006) from the State Inpatient Databases. SETTING All short-term acute-care hospitals in 4 demographically and geographically diverse states. PARTICIPANTS Individuals (age, ≥45y; mean age, 72.6y) with a primary diagnosis of stroke who survived their inpatient stay (N=187,188). The sample was 52.4% women, 79.5% white, 11.4% black, and 9.1% Hispanic. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES (1) Discharge to an institution versus home. (2) For those discharged to home, receipt of home health (HH) versus no HH care. (3) For those discharged to an institution, receipt of inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) care. Multilevel logistic regression analyses were conducted to identify sociodemographic and geographic disparities in PARC use, controlling for illness severity/comorbid conditions, hospital characteristics, and PARC supply. RESULTS Blacks, women, older individuals, and those with lower incomes were more likely to receive institutional care; Hispanics and the uninsured were less likely. Racial minorities, women, older individuals, and those with lower incomes were more likely to receive HH care; uninsured individuals were less likely. Blacks, women, older individuals, the uninsured, and those with lower incomes were more likely to receive SNF versus IRF care. PARC use varied significantly by hospital and geographic location. CONCLUSIONS Several sociodemographic and geographic disparities in PARC use were identified.
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Affiliation(s)
- Janet K Freburger
- Cecil G. Sheps Center for HealthServices Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC 27599-7590, USA.
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