Table 4.
Differences in Length of Stay and Cost by Site of Rehabilitation (IRF and SNF) Among Patients with Stroke
| Author (Year) | Analytic Approach | Comparison | Crude Percentages or Means/Medians | Measure(s) | Summary of findings |
|---|---|---|---|---|---|
| Length of Stay | |||||
| Deutsch et al. (2006) | Appeared to be descriptive. | IRF versus SNF | Graphically shown stratified by case-mix group. | Length of stay (days) Median, 10th and 90th percentiles |
Across most case-mix groups, the median length of IRF stay was significantly shorter than the median length of SNF stay. When not shorter, the median length of stay appeared similar by setting (Figure 2). |
| Hoenig et al. (2001) | Kruskall-Wallis test Mixed model ANOVA conducted on logarithm transformed length of stay adjusting for clustering of patients within hospitals* |
Rehabilitation unit, General hospital unit, versus SNF* (Reference) | Mean (standard deviation) Rehabilitation unit: 21.5 (25.5) Geriatric unit: 19.9 (24.4) SNF*: 16.6 (27.3) |
β coefficient for log-transformed of total acute and post-acute care length of stay | Relative to those in the SNFs*, the length of stay for patients in rehabilitation units was ~2.0 days greater and for those in geriatric units ~1.7 days greater. Rehabilitation unit: adjusted β: 0.30; p-value=0.0001 Geriatric unit: adjusted β: 0.24; p-value=0.001 |
| Medicare Part A Cost | |||||
| Deutsch et al. (2006) | T-tests conducted on logarithm-transformed dollars, stratified by case-mix group Details of how adjusted estimates were obtained were not included. |
IRF versus SNF |
IRF: $12,320 median SNF: $6,215 median |
Facility-specific modifications (e.g. wage, indirect medical education, rural, share of low income patients) were removed from Medicare Part A payments which were then converted to 1997 dollars. Median, 10th and 90th percentiles |
The higher IRF costs relative to SNF costs was apparent across all case-mix groups, but increased with increasing disease severity (e.g., IRF costs $2,106 more than SNF for case-mix group 101; $8,733 for the combined case-mix groups 109, 113, and 114). |
| Buntin et al. (2010) | Generalized estimating equations (linear model) † Instrumental variable analysis† |
IRF versus SNF | Mean (standard deviation) IRF: $29,160 ($23,630) SNF: $19,039 ($14,383) |
Adjusted mean difference in total post-acute care Medicare payments within 120 days of hospital discharge (real dollars 2002–2003) | IRF costs on average $11,261 more than SNF costs (95% confidence interval: $10,933 – $11,590). |
SNF classification included nursing home, intermediate care, or subacute care ward. Covariates included age > 70 years, race, Charlson comorbidity, intubated, second bed section an acute bed section, and site of care (no post-acute, geriatric, rehabilitation).
Covariates included patient demographic (age, age squared, sex, interaction of age and sex, race, urban/rural, Medicaid) and clinical characteristics (13 comorbidities and 17 complications that could influence outcome of post-acute care), indicators of type of stroke, hospital facility factors (size, teaching status, ownership, % Medicare, case-mix, and % low income), county-level HMO penetration, and indicator variables for site of care (IRF, SNF, home). Instruments used were patient-specific measures of accessibility and proximity to post-acute care providers.
Abbreviations: skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), health maintenance organization (HMO)