Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3021 — Geographic Variation in Veterans' Receipt of Specialized Stroke Rehabilitation

Author List:
Cowper DC (Rehabilitation Outcomes Research Center)
Reker DM (Rehabiliation Outcomes Research Center)
Qin H (Rehabilitation Outcomes Research Center)
Marshall C (PM&R Service)

Objectives:
In the past five years, the number of VHA acute rehabilitation units decreased from 72 to 37 (-49%). These reductions occurred despite evidence that well-organized, multidisciplinary rehabilitation improves patient outcomes. The research question posed is: “How do the percentages of stroke patients receiving specialized rehabilitation services vary geographically in the VHA?”

Methods:
Data were obtained from FY-03 VA databases. Identification of stroke patients in Functional Related Group (FRG) classes 4-7 (moderate impairment) was made using the Functional Status and Outcomes Database (FSOD). The receipt of rehabilitation services were identified using the FSOD care class code for acute/subacute rehabilitation unit and ICD-9 CM codes in the PTF (inpatient) and through rehabilitation clinic stop codes and/or CPT codes for rehabilitation services in the SF/SE files (outpatient). ArcGIStm was used to display graphically stroke patients receiving specialized rehabilitation care.

Results:
There is nearly a seven-fold difference in the percentage of moderate impairment stroke patients receiving specialized inpatient rehabilitation services by VISN, ranging from 8.8% in VISN 9 to 60% in VISN 22 (Mean=36.1%, sd=12.6). Less than half of the moderately impaired stroke patients in VISN 7 obtained outpatient rehabilitation services (49.5%); by contrast 77.5% in VISN 15 received outpatient rehabilitation care (Mean=61.2%, sd=6.7). VISNs 15 and 18 had the largest percentage receiving both inpatient and outpatient rehabilitation services (50% and 40.4% respectively; Mean=24.6%, sd=11.1). VISNs with the greatest percentage not receiving any rehabilitation services were VISN 6, VISN 9, and VISN 7 (Mean=27.3%, sd=6.7).

Implications:
There is evidence that moderate impairment stroke survivors benefit from specialized rehabilitation. Geographic variation in the receipt of specialized rehabilitation services for moderate impairment stroke survivors in VHA is evident and further research to discover why this variation exists is warranted.

Impacts:
This research contributes to the understanding of stroke treatment in the VHA. We are able to quantify the number of moderate impairment stroke patients that receive specialized rehabilitation services and document the variation across the 21 VISNs by type of setting (inpatient/outpatient). This effort provides the groundwork for a new Physical Medicine & Rehabilitation Service (PM&RS) supporting indicator for performance.