Comparative Effectiveness of Post-acute Care: Opportunities to Advance Nursing Science

Background

•         Global disability adjusted life years lost due to stroke is projected to grow from 38 million in 1990 to 61 million in 2020. In the U.S., stroke is the leading cause of long-term disability among adults. An estimated 2 million stroke survivors in the U.S. currently cope with permanent stroke related-disabilities, and between 25-74% require some assistance or are fully dependent on caregivers for activities of daily living.

•         Rehabilitation care is central to a stroke patient’s recovery. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability.

•         Among Medicare beneficiaries, stroke patients are the second highest users of post-acute care; however, utilization post-stroke decreased from 70% in 2002 to 58% in 2006.

•         Approximately a third of stroke survivors are rehospitalized. Hospital readmissions are likely to result from a combination of factors including severity of stroke and co-morbid conditions, unresolved problems at hospital discharge, and the quality of immediate post-acute care. The latter has never been studied.

Purpose

•         To examine an episode of stroke care and determine the determinants of post-acute use in elderly stroke survivors, the disparities care, and the comparative effectiveness of settings and patterns of post-acute care use on person- and systems-level outcomes. 

Methods

•         This study integrates Medicare claims data and assessment data with the nation’s largest clinical registry for stroke, the American Heart Association Get With The Guidelines (GWTG)-Stroke registry to examine complex relationships between patient and system level factors, care processes and outcomes.

Session