Impact of Initial Stroke Rehabilitation Placement on Functional Recovery and Cost-effectiveness

项目摘要/摘要 在美国，中风是导致长期残疾的主要原因。中风护理费用的很大一部分是 康复。提供最佳的康复服务有助于减轻患者的长期残疾 卒中。缺乏临床指南，对出院后的长期结果缺乏了解。 从急性中风护理到个人住院康复设施(IRF)或熟练护理设施(SNF) 中风后。我们目前的医疗环境需要更快的决策和及早出院，结果是 可能是不适当的出院到IRF或SNF，因此不能为患者提供最佳结果。这 项目将评估患者(例如，中风严重程度、并发症和社会人口统计)和非患者(例如，床 可用性和保险)在急性住院结束时确定的变量，以确定这些变量中的哪一个 变量与向IRF或SNF(研究目标1)的排放有关。这个项目将跟随客户一起去 确定这些客户端和非客户端变量中的哪些与功能更改相关联-基于 AM-PAC住院患者短期(之后)基本活动能力、日常活动和应用认知工具 出院(IRF或SNF)和长期(中风后6个月；研究目标2)。我们还将确定成本- 基于客户和非客户的IRF、SNF与量身定制的配置的有效策略 目标1(研究目标3)中确定的变量。我们将使用马尔可夫建模来预测相关的成本和质量- 应用健康相关生活质量量表调整卒中患者的寿命年了解其中的结果 这些类似的卒中急性后护理环境(IRF/SNF)在快速发展的医疗环境中非常重要。 这项研究具有重要意义，因为它将提供关于初始客户和非客户变量预测长期- 出院后到IRF或SNF的长期结果，并根据这些变量确定具有成本效益的策略。 这些研究活动为我的职业发展目标提供了体验式学习。这些 包括增加我在保健服务和政策研究方面知识和专长(职业目标1)， 比较效力和成果研究(职业目标2)和成本效益分析(职业目标3)。 这个职业发展奖将让我实现成为一名独立中风人的目标 康复科学调查员。最终的结果将是改善后个人的健康状况。 中风、减少残疾和降低医疗成本。

PROJECT SUMMARY/ABSTRACT Stroke is a leading cause of long-term disability in the United States. A large portion of the cost of stroke care is rehabilitation. Providing optimal rehabilitation services aids in mitigating long-term disability for people after stroke. There are a lack of clinical guidelines and poor understanding of long-term outcomes after discharge from acute stroke care to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) for individuals post-stroke. Our current healthcare climate requires faster decision making and early discharge, and the results may be inappropriate discharge to an IRF or SNF, and thus not providing the patient with optimal outcomes. This project will assess client (e.g., stroke severity, co-morbidities, and sociodemographic) and non-client (e.g., bed availability and insurance) variables identified at the end of the acute hospital stay to determine which of these variables are associated with discharge to an IRF or SNF (Research Aim 1). This project will follow the clients to determine which of these client and non-client variables are associated with functional change—based on the AM-PAC Inpatient “6-Clicks” Basic Mobility, Daily Activity, and Applied Cognitive tools at short-term (after discharge from IRF or SNF) and long-term (6-months post-stroke; Research Aim 2). We will also determine cost- effective strategies of placement into an IRF, to a SNF, versus a tailored, based on the client and non-client variables identified in Aim 1 (Research Aim 3). We will use Markov modeling to predict related costs and quality- adjusted life years using the Health-Related Quality of Life in Stroke Patients. Understanding the outcomes within these similar post-acute care settings (IRF/SNF) for stroke is important in a rapidly evolving healthcare climate. This study is significant because it will provide data about what initial client and non-client variables predict long- term outcomes after discharge to an IRF or SNF and identify cost-effective strategies based on these variables. These research activities provide experiential learning in support of my career development objectives. These include increasing my knowledge and expertise in health services and policy research (Career Aim 1), comparative effectiveness and outcome research (Career Aim 2), and cost-effective analyses (Career Aim 3). This career development award will allow me to achieve my goal of becoming an independent stroke rehabilitation science investigator. The ultimate outcome will be improved health outcomes for individuals post- stroke, reduced disability, and reduced healthcare costs.