STROKE REHABILITATION OUTCOME VARIATION IN VETERANS AFFAIRS REHABILITATION UNITS - ACCOUNTING FOR CASE-MIX

Objective: To assess variation in stroke outcomes and create a case-mi x adjustment model for stroke rehabilitation in Veterans Affairs Medic al Centers. Design: Observational. Setting and Patients: Within Vetera n's Health Administration hospitals, there are 63 acute rehabilitation bedservice units that care for approximately 2,000 stroke patients an nually. Main Outcome Measures: Functional gain in FIM points, length o f stay (LOS), LOS efficiency (FIM gain/LOS). Results: Significant vari ation in average patient functional gain, LOS, and LOS efficiency was observed among the 37 highest volume rehabilitation units. Using analy sis of covariance, a model was developed that adjusted functional gain and LOS (logged LOS) unit means using 10 potential covariates identif ied in a literature review and in pilot studies. Four and six covariat es, respectively, were retained in the final models for FIM gain and L OS. The R-2 for FIM gain and LOS accounted for by rehabilitation unit alone increased from .07 to .31 (FIM gain) and from .13 to .34 (logLOS ) with the addition of the significant covariates to each model. Concl usions: As much as 24% of the variation in two important stroke rehabi litation outcomes is attributable to largely immutable patient and sys tem characteristics (eg, patient function on admission, age, days sinc e stroke onset, year of discharge, marital status, and referral source ). Hence, controlling for case-mix is critical for accurate comparison of unit outcomes. Further, the variation in LOS efficiency between VA rehabilitation units suggests a large potential for cost and resource utilization savings system-wide. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.