Patient Centered Outcomes Research in the Elderly at UTMB

Research Project 2: Comparative Effectiveness of Patient-Centered Outcomes Following IRF and SNF Stroke Rehabilitation

Timothy Reistetter, PhD, OTR

PROJECT DIRECTOR:
Timothy Reistetter, PhD, OTR

Dr. Reistetter is an Associate Professor in the Department of Occupational Therapy in the School of Health Professions. Visit Dr. Reistetter's web bio. He received a BS in Psychology in 1989 from Old Dominion University and an MS in Occupational Therapy in 1996 from Shenandoah University. In 2004, Dr. Reistetter received his PhD in Occupational Therapy from Texas Women's University. He has been a member of the faculty at UTMB since 2008. His research focuses on upper extremity movement and function, spasticity and movement disorders, neurorehabilitation and traumatic brain injury.

SPECIFIC AIMS

Complete a systematic review of stroke rehabilitation studies examining outcomes of inpatient rehabilitation facility (IRF) and skilled nursing facility (SNF) rehabilitation, including self care, mobility, cognitive abilities, discharge destination, rehospitalization and residence in long term care at six months post stroke.

Conduct interviews and questionnaires to determine which outcomes are most important to patients, caregivers, clinicians, and administrators following rehabilitation in an IRF or SNF setting, and how they vary by patient characteristics.

Conduct secondary analyses of CMS data to examine differences in outcomes identified in these aims for persons with stroke who received rehabilitation services in IRF versus SNF, and how they vary by patient characteristics.

SIGNIFICANCE

In the current healthcare climate, policy makers need post-acute-care outcomes research comparing the stroke rehabilitation provided in different types of settings. According the American Heart Association and the American Stroke Association, more than 795,000 individuals sustain a stroke annually. Of these, the great majority are adults 65 years and older. The Center for Medicare and Medicaid Services (CMS) reports that 19% of individuals with a stroke receive rehabilitation in an inpatient rehabilitation hospital/facility (IRF) and 26% receive rehabilitative care in a skilled nursing facility (SNF). These percentages vary by geographic location.

The approach in rehabilitation is to develop an individualized treatment plan that will maximize the patient's functional recovery. Although rehabilitation teams aspire to be client-centered, outcome preferences differ for patients, family members, and clinicians. Studies examining patient preferences in rehabilitation have been limited to questions on desired functional outcomes in IRF settings and have shown that preferences differ between patients and clinicians. We found no studies exploring patient outcome preferences across IRF and SNF settings.

Existing comparative studies of stroke rehabilitation have found that those receiving IRF care experience greater functional improvements compared to those in a SNF. None of these studies specifically examined patient-preferred outcomes. Of these comparative studies, one used the IRF-specific assessment items for both IRF and SNF. The other comparative studies examined outcomes for a subset of hospitals or outcomes. Although these studies examined some key IRF and SNF outcomes, other outcomes that may be important to patients need to be explored and studied in a population based sample.

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Funding for the UTMB Center for Patient-Centered Outcomes Research in the Elderly is provided by the
U.S. Agency for Healthcare Research and Quality (grant #1R24HS022134).