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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1060 — Rehabilitation Costs for VA Stroke Patients: Is Subacute Care Really Less Costly?

Vogel WB (Gainesville Research Enhancement Award Program (REAP)), Reker DM (Kansas City VAMC), Barnett TE (Gainesville REAP), Cowper Ripley DC (Gainesville REAP), Wang X (Gainesville REAP)

Objectives:
To compare the VA costs for post-stroke rehabilitation in acute versus subacute rehabilitation units while controlling for exogenous factors that influence costs.

Methods:
We used chart-abstracted clinical data and DSS cost data on 481 confirmed VA stroke patients who received rehabilitation services on acute or subacute rehabilitation units during FY 02-03. Based on the methods suggested by Manning and Mullahy (2001), we fitted reduced-form generalized linear models with log links and Poisson distributions to explain VA cost differences between acute and subacute rehabilitation units for the index rehabilitation stay, short-term (index discharge to three months), and long-term (three months to two years). Our models controlled for functional status at admission to rehabilitation (as measured by the total Functional Independence Measure), sociodemographics (age and marital status), and type of rehabilitation unit (acute vs. subacute).

Results:
Contrary to conventional wisdom, we found that acute rehabilitation was associated with statistically significant lower costs than subacute rehabilitation over the full two year period (-10%), as well as during the index rehabilitation stay (-17%) and over the short-term (-20%). By contrast, subacute rehabilitation was less costly for the long-term (-15%), but these cost savings were insufficient to offset the cost advantages accruing to acute rehabilitation during the index stay and short-term periods.

Implications:
These results have critical implications for the VA given the trend toward replacing acute rehabilitation units with subacute units. Over the past decade, the VA has closed 34 acute rehabilitation units and has opened 18 subacute rehabilitation units. While prior research has suggested better compliance with stroke rehabilitation guidelines in acute units compared to subacute units, the present results suggest that acute rehabilitation units not only provide better care for stroke patients, but are also less costly.

Impacts:
The VA may want to undertake a careful review of the clinical and economic implications of its recent restructuring of inpatient rehabilitation. For stroke patients, such restructuring may not be advisable on either clinical or economic grounds.


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