Abstract Body: Introduction: There has been an ongoing debate regarding the effectiveness of inpatient rehabilitation facility (IRF) and skilled nursing facility (SNF) in promoting functional recovery. Home time is a valid measure of functional recovery in stroke patients that is often used in outcome studies. Considering that SNF patients have twice the length of stay compared to IRF patients, our objective was to explore whether home time is a suitable measure to compare the effectiveness between IRF and SNF in achieving functional recovery.
Methods: We probabilistically linked data from Michigan’s Coverdell Stroke Program and Michigan Value Collaborative multipayer claims database for Medicare FFS beneficiaries hospitalized with acute stroke (ICD-10 I61-I63) between 2016-2020. Patients admitted to IRF or SNF after hospital discharge were confirmed using claims data. Home time was calculated over 90-days and 1-year following hospital discharge by subtracting the number of days spent in inpatient setting (i.e., IRF, SNF, and long-term care) from the number of days alive. We calculated the crude and inverse probability of treatment weighted (IPTW) mean difference of home time between IRF and SNF groups. We conducted a sensitivity analysis to examine the effect of time spent in the same rehabilitation setting over 30-days post discharge on home time.
Results: From a cohort of 14,316 linked patients, we identified 2,995 (20.9%) and 2,948 (20.6%) patients directly admitted to IRF or SNF following stroke hospitalization, respectively. Compared to SNF patients, IRF patients were younger, more likely to be male, had minor strokes (NIHSS 1-4), and were able to ambulate at discharge. The unadjusted 90-day and 1-year mean home time were 15.6 and 67.6 days higher among IRF patients compared to SNF patients, respectively (Table). After accounting for rehabilitation time during 30-days post discharge, 90-day and 1-year unadjusted mean difference in home time remained higher among IRF patients compared to SNF patients but was reduced to 4.6 and 56.5 days, respectively. Using the amended home time, the adjusted 90-days mean difference was almost zero and not significantly different (0.5 days) but remained significantly different over 1-year (35.7 days).
Conclusions: Home time is heavily impacted by rehabilitation length of stay. Future rehabilitation related studies should be cautious when using home time as a measure of functional recovery, especially over short duration of follow-up.