Abstract Body: Introduction: Two-thirds of US stroke patients undergo rehabilitation post-discharge with about 20% and 25% receiving care at an inpatient rehabilitation facility (IRF) and skilled nursing facility (SNF), respectively. Total rehabilitation time for stroke patients discharged to SNF are about twice as long as those of IRF, but the effect of hospital readmission (to acute care) on the continuity of rehabilitation care in either setting is not known.
Methods: We probabilistically linked data from Michigan’s Coverdell Stroke Program and Michigan Value Collaborative claims database for Medicare FFS beneficiaries following acute stroke (ICD-10 I61-I63) between 2016-2020. Patients admitted to IRF or SNF after hospital discharge were confirmed using claims data. We followed patients for 30 days post-discharge and compared the all-cause readmission rate, initial rehabilitation length of stay, 30-day total rehabilitation length of stay (in the same setting), and number of admissions to the same rehabilitation setting between IRF and SNF patients.
Results: From an initial cohort of 14,316 patients, we identified 2,995 (20.9%) and 2,948 (20.6%) directly admitted to IRF or SNF following stroke hospitalization, respectively. Compared to SNF patients, IRF patients were younger, and more likely to be male, have minor strokes (NIHSS 1-4), and be able to ambulate at hospital discharge. Over 30 days of follow up, 12.6% (n=376) of IRF and 19.6% (n=577) of SNF patients were readmitted at least once to an acute hospital setting (Table). Of the patients who experienced readmission, SNF patients were more likely to be readmitted to a SNF rehabilitation setting compared to IRF patients being readmitted to an IRF setting (mean number of SNF admissions = 2.1 vs mean number of IRF admissions = 1.3). The mean length of stay of the initial IRF and SNF care settings were 14.6 (SD=8.0) and 11.5 (SD=8.2) days, respectively. However, the mean cumulative length of stay in the same rehabilitation setting over the 30-day period increased slightly to 15.3 (SD=8.1) days for IRF patients but increased substantially to 26.4 (SD=21.3) days for SNF patients.
Conclusions: Readmission to the acute hospital has a disrupting effect on the continuity of rehabilitation care especially for SNF patients who are less likely to complete their initial rehabilitation stay. However, because most SNF patients return to SNF, the cumulative amount of rehabilitation care is close to the theoretical 30 day maximum.