Performance Improvement 2008. How Do Health Care Outcomes Vary in Different Medicare Post Acute Settings for Patients Who Have Had Strokes?


This study compared the cost and outcomes of post acute care services after hospitalization for a stroke. After hospitalization, over a third of Medicare beneficiaries use post acute care services, including skilled nursing facilities, inpatient rehabilitation, long-term care hospital, home health care services or outpatient services. We know little about the effectiveness of these settings. Researchers identified the functional status of the person before the stroke, at the beginning of post acute care services, and 90 days after the start of those services. Most patients experienced multiple post acute care settings which added to the overall costs to Medicare.

Patients who were admitted to an inpatient rehabilitation facility and then went a skilled nursing facility had the same outcomes as patients who went directly to a skilled nursing facility––but cost three times as much. Patients using (clinic/hospital based) outpatient therapy received more therapy services and had better outcomes than patients receiving services at home. While home health service had higher total costs and Medicare costs, out-of-pocket costs to beneficiaries were substantially higher for patients using outpatient therapy than home health. This study provided essential information to help reform the post acute care system.

Report Title: A Study of Stroke Post-Acute Care and Outcomes: Final Report,
Agency Sponsor:
ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Susan Polniaszek, 202-690-6443
Performer: University of Colorado
PIC ID: 8531

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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