Acute and subacute rehabilitation for stroke: a comparison.

Subacute rehabilitation, a recent innovation, is a less intense form of traditional inpatient rehabilitation. This study is a retrospective comparison of stroke treatment in a comprehensive inpatient service (acute rehabilitation) and subacute rehabilitation in a skilled nursing facility. Consecutive records during 1990 and 1991 resulted in 331 patients at the acute level and 97 at the subacute. Analysis of patient characteristics found few major differences between the two populations. Scrutiny of billing records found that acute program patients had twice as much treatment during a stay, twice the daily treatment hours, and twice the average charge per day. Acute rehabilitation patients showed substantially greater gains in functional impairment measures (FIM), but the proportion of patients discharged to the community varied little. Cost-effectiveness analysis found that the charge per successful discharge was more than double for acute rehabilitation. The charge per one point of FIM gain also was substantially higher. Although subacute rehabilitation was found to be more cost-effective than acute, additional research is needed to establish policies regarding rehabilitation services.