Outcomes after Discharge from Inpatient Rehabilitation or Skilled Nursing in Patients Post-Stroke with Medicare Advantage

Thursday, November 10, 2022

12:47 PM – 12:52 PM

Location: Station 3

Presenting Author(s)

Heather A. Hayes, DPT, PhD

Associate Professor
University of Utah
Salt Lake City, Utah, United States

Non-presenting Author(s)

Christine McDonough, PT, PhD

Assistant Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Research Objectives: Determine differences in outcomes (functional, readmission, and community discharge) after placement in an Inpatient Rehabilitation Facility (IRF) or Skilled Nursing Facility (SNF) for patients post-ischemic stroke who have a Medicare Advantage (MA) plan.

Design: A retrospective cohort study.

Setting: Individuals post-stroke discharged to an IRF / SNF post-acute care setting, was conducted with data from an MA convener company.

Participants: A group 3,377 per group (IRF and SNF), matched on a propensity score.

Interventions: No intervention.

Main Outcome Measures: Multivariable logistic regression analyses were performed with the dependent variables being facility (IRF [referent] or SNF). Three independent variables; functional discharge outcomes (Activity Measure for Post-Acute Care [AM-PAC] CAT Basic Mobility [BM], Daily Activity [DA], and Applied Cognition [AC]); readmission to acute care hospital; and community discharge were assessed. Results are expressed as beta coefficients and Odds Ratio (95% CI).

Results: After controlling for age, gender, length of stay, comorbidities, and admit function; the change in the AM-PAC BM score, β = 1.73 points (95% CI, 1.38, 2.08), p < 0.001 was higher in individuals in an IRF at discharge compared to a SNF. The DA score, β = -0.19 points (-0.52, 0.15), p = 0.27. The AC score, β = 1.24 points (0.92, 1.56), p < 0.001. Individuals discharged to an IRF were 40% less likely to be readmitted to the acute care hospital, OR = 0.64 (0.54, 0.76), p < 0.001. There was no difference between the groups discharged to community or not, OR = 0.95, (0.84, 1.09), p = 0.48.

Conclusions: For individuals post-stroke with MA plans, we found that functional outcomes were not clinically different after participation in an IRF or SNF. After controlling for the other variables, individuals sent to a SNF were more likely to be readmitted to an acute care hospital, but there was no difference between groups in discharge to a community setting or not.

Author(s) Disclosures: The authors have nothing to disclose

Learning Objectives:

Upon completion, participant will be able to understand the role of a convener company for Medicare Advantage plans.
Upon completion, participant will understand the role of physical function in rehabilitation outcomes for individuals post-stroke.
Upon completion, participant will understand the outcomes of individuals post-stroke who are being discharged from inpatient rehabilitation or skilled nursing facility who have a Medicare Advantage plan.