Deutsch Anne, Granger Carl V, Heinemann Allen W, Fiedler Roger C, DeJong Gerben, Kane Robert L, Ottenbacher Kenneth J, Naughton John P, Trevisan Maurizio
Department of Rehabilitation Medicine, School of Medicine and Biomedical Sciences, The State University of New York, Uniform Data System for Medical Rehabilitation, Amherst, NY, USA.
Stroke. 2006 Jun;37(6):1477-82. doi: 10.1161/01.STR.0000221172.99375.5a. Epub 2006 Apr 20.
To assess whether poststroke rehabilitation outcomes and reimbursement for Medicare beneficiaries differ across inpatient rehabilitation facilities (IRFs) and skilled nursing facility (SNF) subacute rehabilitation programs.
Clinical data were linked with Medicare claims for 58,724 Medicare beneficiaries with a recent stroke who completed treatment in 1996 or 1997 in IRFs and subacute rehabilitation SNFs that subscribed to the Uniform Data System for Medical Rehabilitation. Outcome measures were discharge destination, discharge FIM ratings and Medicare Part A reimbursement during the institutional stay.
IRF patients that were more likely to have a community-based discharge, compared with rehabilitation SNF patients, were patients with mild motor disabilities and FIM cognitive ratings of 23 or greater (adjusted odds ratio [AOR]=2.19; 95% CI: 1.52 to 3.14), patients with moderate motor disabilities (AOR=1.98; 95% CI: 1.49 to 2.61), patients with significant motor disabilities (AOR=1.26; 95% CI: 1.01 to 1.57) and patients younger than 82 with severe motor disabilities (AOR=1.43; 95% CI: 1.25 to 1.64). IRF patients with significant and severe motor disabilities achieved greater motor function of 2 or more FIM units compared with rehabilitation SNF patients. Medicare Part A payments for IRFs were higher than rehabilitation SNF payments across all subgroups.
For most patients, poststroke rehabilitation in the more costly and intensive IRFs resulted in higher functional outcomes compared with care in a SNF-based rehabilitation program. IRF and SNF outcomes were similar for patients with minimal motor disabilities and patients with mild motor disabilities and significant cognitive disabilities. Cost-effectiveness analyses require considering the costs of the full episode of care.
评估中风后康复结局以及医疗保险受益人的报销情况在住院康复机构（IRF）和熟练护理机构（SNF）的亚急性康复项目之间是否存在差异。
将临床数据与58724名近期中风的医疗保险受益人的医疗保险理赔数据相链接，这些受益人于1996年或1997年在订阅了医疗康复统一数据系统的IRF和亚急性康复SNF中完成治疗。结局指标包括出院去向、出院时的FIM评分以及住院期间医疗保险A部分的报销情况。
与康复SNF患者相比，更有可能以社区为基础出院的IRF患者包括：轻度运动障碍且FIM认知评分为23或更高的患者（调整优势比[AOR]=2.19；95%置信区间[CI]：1.52至3.14）、中度运动障碍患者（AOR=1.98；95%CI：1.49至2.61）、重度运动障碍患者（AOR=1.26；95%CI：1.01至1.57）以及82岁以下重度运动障碍患者（AOR=1.43；95%CI：1.25至1.64）。与康复SNF患者相比，有重度和极重度运动障碍的IRF患者在运动功能上提高了2个或更多FIM单位。在所有亚组中，IRF的医疗保险A部分支付高于康复SNF支付。
对于大多数患者而言，与基于SNF的康复项目相比，在成本更高、强度更大的IRF中进行中风后康复可带来更高的功能结局。对于运动障碍最小的患者以及轻度运动障碍且有显著认知障碍的患者，IRF和SNF的结局相似。成本效益分析需要考虑整个护理过程的成本。
