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

项目总结/摘要 中风是美国长期残疾的主要原因。中风护理的大部分费用是 康复活动.提供最佳的康复服务有助于减轻人们在 中风缺乏临床指南，对出院后的长期结果了解不足 从急性中风护理到住院康复机构（IRF）或专业护理机构（SNF）， 中风后我们目前的医疗环境需要更快的决策和早期出院，结果 可能是不适当地出院至IRF或SNF，因此无法为患者提供最佳结局。这 项目将评估客户（例如，中风严重程度、共病和社会人口统计学）和非客户（例如，床 可用性和保险）变量，以确定哪些这些 变量与向IRF或SNF放电相关（研究目标1）。该项目将遵循客户 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“6次点击”基本移动性、日常活动和短期应用认知工具（ 从IRF或SNF出院）和长期（卒中后6个月;研究目的2）。我们还将确定成本- 根据客户和非客户的情况， 目标1中确定的变量（研究目标3）。我们将使用马尔可夫模型来预测相关的成本和质量- 使用卒中患者健康相关生活质量的调整生命年。了解内部的结果 这些类似的卒中急性期后护理环境（IRF/SNF）在快速发展的医疗保健环境中非常重要。 这项研究意义重大，因为它将提供有关初始客户和非客户变量预测长期的数据， 出院到IRF或SNF后的长期结局，并根据这些变量确定成本效益高的策略。 这些研究活动提供了经验学习，以支持我的职业发展目标。这些 包括增加我在卫生服务和政策研究方面的知识和专业知识（职业目标1）， 比较有效性和结果研究（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独立中风者的目标 康复科学研究员最终的结果将是改善个人的健康结果后， 中风，减少残疾，降低医疗费用。

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.