Researchers at the University of Texas Branch at Galveston recently round that people who have had a stroke recover differently depending on which part of the United States they live in.
The team, led by UTMB’s Dr. Timothy Reistetter, an associate professor in the Department of Occupational Therapy, examined over 143,000 patients with stroke who were discharged from inpatient rehabilitation during 2006 and 2007. Considering that people who have had strokes represent the largest group benefiting from inpatient medical rehabilitation services in the nation, researchers aimed to find any regional variations in outcomes for these patients.
To measure these variations, researchers focused on the length of stay before patients were discharged to the community and discharge functional status ratings, such as motor and cognitive functions, across ten regions defined by the Centers for Medicare and Medicaid Services.
As a result, researchers found significant differences across the country, most notably in community discharge rates – an important quality indicator for rehabilitation – and length of stay. The percentage of patients discharged to the community ranged from 79.1% in the Southwest to 59.4% in the Northeast. These two regions, the study highlights, present different types and availability of resources to assist individuals who attempt to reintegrate into the community after having a stroke. For example, the Northeast included fewer Medicare patients and has greater racial/ethic diversity, which is a main influence factor on discharge decisions, since people from minority groups were shown to be less likely to receive institutional care than non-Hispanic whites.
Furthermore, the length of stay varied by 2.1 days among the ten analyzed regions, the region of Boston having the longest length of stay, at 18.3 days, and the regions of Chicago and San Francisco having the shortest, at 16.2 days.
The study shows, on the other hand, that functional status and change in function as measured are relatively stable across regions, with all analyzed regions demonstrating functional change of approximately 25 points from admission to discharge, which reflects improvement in functional independence during rehabilitation.
Understanding this variability will ultimately help rehabilitation professionals and administrators improving care in areas with poor outcomes, Reistetter said. In order to implement adequate quality improvement programs in each region, it is important to describe region-specific outcomes of rehabilitative care, he added.
The study’s co-authors are Kenneth J. Ottenbacher, Amol M. Karmarkar and James E. Graham of UTMB’s Division of Rehabilitation Sciences; Karl Eschbach, Jean Freeman and Yong-Fang Kuo of UTMB’s Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine; and Dr. Carl V. Granger, Uniform Data System for Medical Rehabilitation, Buffalo, NY.
The study, published in the journal Archives of Physical Medicine and Rehabilitation, was funded by the National Institute of Child Health and Human Development, National Institutes of Health; the Institute for Translational Sciences at the University of Texas Medical Branch with support in part by a National Institutes of Health Clinical and Translational Science Award; the Agency for Healthcare Research and Quality; and the National Institutes of Health.