POSTSTROKE REHABILITATION IN OLDER AMERICANS - THE MEDICARE EXPERIENCE

OBJECTIVES. This study examines the poststroke rehabilitation experien ce for a 20% sample of Medicare patients age 65 years and older admitt ed to an acute-tare hospital with a stroke diagnosis during the 6-mont h interval, January 1, 1991 to June 30, 1991. Their Medicare claims da ta are used for two purposes: to identify current poststroke rehabilit ation practice in the US population age 65 years and older, and to eva luate the importance of practice variation within this population. MET HODS. Regarding the first objective, the authors develop estimates for many poststroke rehabilitation use and cost parameters that formerly were unmeasured. With respect to the second objective, the authors con struct and compare average service use rates across ail stroke patient s in a census division and across all stroke patients residing in the 30 largest metropolitan statistical areas. RESULTS. The authors' Medic are claims analysis indicates that 73% of stroke survivors received ei ther postacute institutional or ambulatory rehabilitation care during the first 6 months poststroke. The published stroke literature, on the other hand, focuses on the minority of stroke survivors, 16.5% in the Medicare data, who were admitted to an inpatient rehabilitation hospi tal. Regarding the second study objective, the Medicare analysis provi des graphic evidence that poststroke rehabilitation practice varies su bstantially from one geographic area to another and that practice diff erences translate into large geographic-related differences in the cos t of poststroke rehabilitation. CONCLUSIONS. The authors believe the f indings demonstrate a problem with inconsistent poststroke rehabilitat ion practice.