Study Suggests Inpatient Rehabilitation Better for Stroke Recovery Than SNF

An article, “Comparison of Functional Status Improvements Among Patients with Stroke Receiving Postacute Care in Inpatient Rehabilitation vs Skilled Nursing Facilities,” was recently published in the Journal of the American Medical Association (JAMA) Network that highlights the findings from a cohort study of patients who received post-acute care in inpatient rehabilitation facilities (IRFs) or skilled nursing facilities (SNFs) following a stroke. The study examined changes in functional status. Stroke was selected because it is a major cause of disability in the United States and an important public health issue, and often requires a range of treatments and expertise.

The study included patients with stroke who were discharged from acute care hospitals to IRFs or SNFs from January 1, 2013 to November 30, 2014. Medicare claims were used to link to IRF and SNF assessments. The study does include limitations that were encountered, such as the findings don’t take into account other post-acute settings (home health, long-term care hospitals, etc.) and the inability to examine cognitive function before and after the stroke, stroke severity, or location of the stroke.

The findings of the study suggest that the care in an IRF was associated with greater improvement in mobility and self-care compared with care in an SNF. Their findings indicate the need to carefully manage discharge to post-acute care based on the patient’s needs and potential for recovery. Post-acute reform based on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) must avoid a payment system that shifts patients with stroke who could benefit from intensive inpatient rehabilitation to lower cost settings. The IMPACT Act of 2014 is a bill that is intended to change and improve Medicare’s post-acute care services and how they are reported. Contact RCPA Rehabilitation Services Director Melissa Dehoff with questions.