Study Compares Stroke Care in VA Community Living Centers with Private, VA-Contracted Nursing Homes
Effective post-stroke rehabilitation care can speed patient recovery and minimize patient functional disabilities. VA community living centers (CLCs) and private, VA-contracted community nursing homes (CNHs) are the two major sources of institutional long-term care for Veterans diagnosed with stroke, but there are very few empirical studies evaluating and comparing the use and/or quality of care provided to Veterans in CLCs versus CNHs. This study is part of a larger investigation comparing the use and functional outcomes between Veterans in CLCs and VA-contracted CNHs. Using VA and Centers for Medicare and Medicaid Services (CMS) data, investigators identified 18,272 Veterans who were diagnosed with stroke and admitted to CLCs (n=12,660 or 69%) or VA-contracted CNHs (n=5,612 or 31%) from January 2006 through December 2009, and who had received at least two health status assessments during their stay. The main outcomes measured were the number of days of rehabilitation therapy (i.e., physical, occupational, speech, respiratory therapy) and restorative nursing care (i.e., active/passive range of motion, walking, dressing/grooming). For this analysis, 133 CLCs and 2,346 CNHs were included.
- Compared with Veterans residing at CNHs, Veterans residing at CLCs had fewer average rehabilitation therapy days (both adjusted and unadjusted), but were significantly more likely to receive restorative nursing care.
- For rehabilitation therapy, Veterans in CLCs had lower user rates (75% vs. 76%) and fewer observed therapy days (4.9 vs. 6.4) compared to Veterans in CNHs. For restorative nursing care, Veterans in CLCs had higher user rates (34% vs. 31%), more observed average care days (9.4 vs. 5.9), and more adjusted days for restorative nursing care.
- Study data were from multiple sources, thus investigators were limited by availability of some important factors in comparison between CLCs and CNHs, i.e., facility staffing level or staff hours.
- Additonal data that were unavailable included why the decision was made to place Veterans in CNHs, which could be due to local CLC bed shortage or the Veteran's preference for a CNH's close proximity to home or family members.
- This study provided a comprehensive analysis of rehabilitation therapy and restorative nursing care received by Veterans with stroke at VA CLC and VA-contracted CNHs, as well as the geographic variation of this utilization.
This study was funded by HSR&D (IIR 11-330). Drs. Jia, Pei, Sullivan, Cowper Ripley, Wu, Vogel, and Wang are part of HSR&D's Center of Innovation on Disability and Rehabilitation Research (CINDRR) in North Florida/South Georgia and Tampa, FL.
Jia H, Pei Q, Sullivan C, et al. Post-Stroke Rehabilitation and Restorative Care Utilization: A Comparison between VA Community Living Centers and VA-Contracted Community Nursing Homes. Medical Care. March 2016;54(3):235-242.