PMID- 28965738
OWN - NLM
STAT- MEDLINE
DCOM- 20190128
LR  - 20191008
IS  - 1532-821X (Electronic)
IS  - 0003-9993 (Print)
IS  - 0003-9993 (Linking)
VI  - 99
IP  - 6
DP  - 2018 Jun
TI  - Postacute Care Setting, Facility Characteristics, and Poststroke Outcomes: A 
      Systematic Review.
PG  - 1124-1140.e9
LID - S0003-9993(17)31122-X [pii]
LID - 10.1016/j.apmr.2017.09.005 [doi]
AB  - OBJECTIVES: To synthesize research comparing poststroke health outcomes between 
      patients rehabilitated in skilled nursing facilities (SNFs) and those in 
      inpatient rehabilitation facilities (IRFs) as well as to evaluate relations 
      between facility characteristics and outcomes. DATA SOURCES: PubMed and CINAHL 
      searches spanned January 1, 1998, to October 6, 2016, and encompassed MeSH and 
      free-text keywords for stroke, IRF/SNF, and study outcomes. Searches were 
      restricted to peer-reviewed research in humans published in English. STUDY 
      SELECTION: Observational and experimental studies examining outcomes of adult 
      patients with stroke rehabilitated in an IRF or SNF were eligible. Studies had to 
      provide site of care comparisons and/or analyses incorporating facility-level 
      characteristics and had to report >/=1 primary outcome (discharge setting, 
      functional status, readmission, quality of life, all-cause mortality). 
      Unpublished, single-center, descriptive, and non-US studies were excluded. 
      Articles were reviewed by 1 author, and when uncertain, discussion with study 
      coauthors achieved consensus. Fourteen titles (0.3%) were included. DATA 
      EXTRACTION: The types of data, time period, size, design, and primary outcomes 
      were extracted. We also extracted 2 secondary outcomes (length of IRF/SNF stay, 
      cost) when reported by included studies. Effect measures, modeling approaches, 
      methods for confounding adjustment, and potential confounders were extracted. 
      Data were abstracted by 1 author, and the accuracy was verified by a second 
      reviewer. DATA SYNTHESIS: Two studies evaluating community discharge, 1 study 
      evaluating the predicted probability of readmission, and 3 studies evaluating 
      all-cause mortality favored IRFs over SNFs. Functional status comparisons were 
      inconsistent. No studies evaluated quality of life. Two studies confirmed 
      increased costs in the IRF versus SNF setting. Although substantial facility 
      variation was described, few studies characterized sources of variation. 
      CONCLUSIONS: The few studies comparing poststroke outcomes indicated better 
      outcomes (with higher costs) for patients in IRFs versus those in SNFs. 
      Contemporary research on the role of the postacute care setting and its 
      attributes in determining health outcomes should be prioritized to inform 
      reimbursement system reform.
CI  - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by 
      Elsevier Inc. All rights reserved.
FAU - Alcusky, Matthew
AU  - Alcusky M
AD  - Department of Quantitative Health Sciences, University of Massachusetts Medical 
      School, Worcester, MA. Electronic address: matthew.alcusky@umassmed.edu.
FAU - Ulbricht, Christine M
AU  - Ulbricht CM
AD  - Department of Quantitative Health Sciences, University of Massachusetts Medical 
      School, Worcester, MA.
FAU - Lapane, Kate L
AU  - Lapane KL
AD  - Department of Quantitative Health Sciences, University of Massachusetts Medical 
      School, Worcester, MA.
LA  - eng
GR  - TL1 TR001454/TR/NCATS NIH HHS/United States
GR  - UL1 TR001453/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Systematic Review
DEP - 20170928
PL  - United States
TA  - Arch Phys Med Rehabil
JT  - Archives of physical medicine and rehabilitation
JID - 2985158R
SB  - IM
MH  - Age Factors
MH  - Cognition Disorders/epidemiology
MH  - Disability Evaluation
MH  - Humans
MH  - Length of Stay
MH  - Patient Readmission/statistics & numerical data
MH  - *Quality of Life
MH  - Rehabilitation Centers/*organization & administration
MH  - Sex Factors
MH  - Skilled Nursing Facilities/*organization & administration
MH  - Stroke Rehabilitation/mortality/*statistics & numerical data
MH  - Subacute Care/*organization & administration
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC5874162
MID - NIHMS918888
OTO - NOTNLM
OT  - Outcome assessment (health care)
OT  - Rehabilitation
OT  - Skilled nursing facilities
OT  - Stroke rehabilitation
OT  - Subacute care
COIS- Conflicts of interest: None
EDAT- 2017/10/03 06:00
MHDA- 2019/01/29 06:00
PMCR- 2019/06/01
CRDT- 2017/10/03 06:00
PHST- 2017/07/21 00:00 [received]
PHST- 2017/08/31 00:00 [revised]
PHST- 2017/09/03 00:00 [accepted]
PHST- 2017/10/03 06:00 [pubmed]
PHST- 2019/01/29 06:00 [medline]
PHST- 2017/10/03 06:00 [entrez]
PHST- 2019/06/01 00:00 [pmc-release]
AID - S0003-9993(17)31122-X [pii]
AID - 10.1016/j.apmr.2017.09.005 [doi]
PST - ppublish
SO  - Arch Phys Med Rehabil. 2018 Jun;99(6):1124-1140.e9. doi: 
      10.1016/j.apmr.2017.09.005. Epub 2017 Sep 28.