National Meeting 2007

3015 — Veterans, Multiple System Use, and Stroke Rehabilitation: Who Gets What from Where?

Cowper DC (COE Gainesville) , Jia H (COE Gainesville), Qin H (COE Gainesville), Reker DM (Kansas City VAMC)

Objectives:
(1) To examine multiple system health care use patterns of Florida stroke survivors who had a VHA hospitalization; (2) to track care one year post-stroke health services use to determine where and what types of rehabilitation services patients obtain; and (3) to understand the spectrum of rehabilitation services veterans receive inside and outside of VHA.

Methods:
Data for analyses came from 3 sources: AAC, VIReC, and the Florida Agency for Health Care Administration. Inpatient rehabilitation at index hospitalization was captured in the VHA databases through a VA national database of patient function and ICD-9 codes. Inpatient rehabilitation was captured in the Medicare database if any dollar amount in Part A was spent on PT, OT and/or Speech and Language Pathologist services. The stroke cohort for the study received care during 2000-2001 and numbered 1,825. Based on their initial source of inpatient care, patients were categorized as VHA-first (61%), Medicare-first (37%), and Medicaid-first (2%).

Results:
(1) VHA-first patients, compared to Medicare-first, received less rehabilitation service both during index hospitalization (39% versus 88%) and 12-month post-index (52% versus 61%); (2) VHA provided a safety net in post-stroke rehabilitation for its stroke patients, e.g., among those who received rehabilitation services 12-month post-stroke 88% of VHA-first, 100% of Medicaid-first and 33% of Medicare-first patients relied on VHA for their post-stroke rehabilitation; (3) 8% of VHA-first and 49% of Medicare-first received the services covered by the Medicare program; and 4% of VHA-first and 18% of Medicare-first patients used their dual VHA-Medicare benefits for post-stroke care.

Implications:
Patients with initial stroke inpatient care at VHA received less rehabilitation services both during the index hospitalization and 12-months post stroke which may represent a less severe group of patients. VHA does provide a safety net for its stroke patients who needed post-stroke rehabilitation care regardless of the sources of initial stroke care.

Impacts:
Our results can serve as a basis for future studies on the rehabilitation patterns of stroke survivors in other geographic regions and the methodologies developed in using multiple sources of administrative data for rehabilitation outcomes research can be adopted.