Does Postacute Care Site Matter? A Longitudinal Study Assessing Functional Recovery After a Stroke

Objective: To determine the impact of postacute care site on stroke outcomes. Design: Prospective cohort study. Setting: Four northern California hospitals that are part of a single health maintenance organization. Participants: Patients with stroke (N=222) enrolled between February 2008 and July 2010. Intervention: Not applicable. Main Outcome Measure: Baseline and 6-month assessments were performed using the Activity Measure for Post Acute Care (AM-PAC), a test of self-reported function in 3 domains: Basic Mobility, Daily Activities, and Applied Cognition. Results: Of the 222 patients analyzed, 36% went home with no treatment, 22% received home health/outpatient care, 30% included an inpatient rehabilitation facility (IRF) in their care trajectory, and 13% included a skilled nursing facility (but not IRF) in their care trajectory. At 6 months, after controlling for important variables such as age, functional status at acute care discharge, and total hours of rehabilitation, patients who went to an IRF had functional scores that were at least 8 points higher (twice the minimally detectable change for the AM-PAC) than those who went to a skilled nursing facility in all 3 domains and in 2 of 3 functional domains compared with those who received home health/outpatient care. Conclusions: Patients with stroke may make more functional gains if their postacute care includes an IRF. This finding may have important implications as postacute care delivery is reshaped through health care reform. Archives of Physical Medicine and Rehabilitation 2013;94:622-9 (C) 2013 by the American Congress of Rehabilitation Medicine