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Patients most likely to benefit from stroke rehabilitation are least likely to be selected

Between 1987 and 1998, hospital stays for stroke patients declined by half, but Medicare nursing home admissions for stroke increased nearly three-fold. However, the patients most likely to benefit from stroke rehabilitation in nursing homes—such as those who are cognitively impaired, incontinent, or unable to conduct ordinary daily activities—are not being selected for it, according to a study by Case Western Reserve University researchers.

In a study supported in part by the Agency for Healthcare Research and Quality (T32 HS00059), they examined the outcomes of 2,013 stroke patients admitted from an acute care hospital to 945 Medicaid-certified nursing homes in Ohio between 1994 and 1996. Using data from the Ohio Minimum Dataset Plus and Ohio death certificate files, the researchers compared patients who received stroke rehabilitation with those who did not.

After adjusting for patient need for rehabilitation and severity of illness, patients who received rehabilitation were 1.58 times as likely to be discharged to the community than those who did not. However, those most likely to benefit from stroke rehabilitation based on clinical factors (high need) were less likely to be discharged to the community than those least likely to benefit. Patients who were less likely to receive rehabilitation were more likely to have do-not-resuscitate orders and to have Medicaid as their primary insurance.

More details are in "Are we selecting the right patients for stroke rehabilitation in nursing homes?" by Patrick K. Murray, M.D., M.S., Neal V. Dawson, M.D., Charles L. Thomas, B.S., and Randall D. Cebul, M.D., in the May 2005 Archives of Physical and Medical Rehabilitation 86, pp. 876-880.

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