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Center of Innovation on Disability & Rehabilitation Research

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Stroke Care Comparison Article Merits Attention

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Huanguang "Charlie" Jia, lead author of the article chosen as the March 2016 HSR&D Publication Brief.

Friday, March 11, 2016

Effective post-stroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. VA community living centers (CLCs) and private, VA-contracted community nursing homes (CNHs) are the two major sources of institutional long-term care for Veterans diagnosed with stroke, but there are very few empirical studies evaluating and comparing the use and/or quality of care provided to Veterans in CLCs versus CNHs. This study is part of a larger investigation comparing the use and functional outcomes between Veterans in CLCs and VA-contracted CNHs. Using VA and Centers for Medicare and Medicaid Services (CMS) data, investigators identified 18,272 Veterans who were diagnosed with stroke and admitted to CLCs (n=12,660 or 69%) or VA-contracted CNHs (n=5,612 or 31%) from January 2006 through December 2009, and who had received at least two health status assessments during their stay. The main outcomes measured were the number of days of rehabilitation therapy (i.e., physical, occupational, speech, respiratory therapy) and restorative nursing care (i.e., active/passive range of motion, walking, dressing/grooming). For this analysis, 133 CLCs and 2,346 CNHs were included.

FINDINGS:

  • Compared with Veterans residing at CNHs, Veterans residing at CLCs had fewer average rehabilitation therapy days (both adjusted and unadjusted), but were significantly more likely to receive restorative nursing care.
  • For rehabilitation therapy, Veterans in CLCs had lower user rates (75% vs. 76%) and fewer observed therapy days (4.9 vs. 6.4) compared to Veterans in CNHs. For restorative nursing care, Veterans in CLCs had higher user rates (34% vs. 31%), more observed average care days (9.4 vs. 5.9), and more adjusted days for restorative nursing care.

AUTHOR/FUNDING INFORMATION:

This study was funded by HSR&D (IIR 11-330). Drs. Jia, Pei, Sullivan, Cowper Ripley, Wu, Vogel, and Wang are part of HSR&D’s Center of Innovation on Disability and Rehabilitation Research (CINDRR) in North Florida/South Georgia and Tampa, FL.

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