The structure and structural effects of VA rehabilitation bedservice care for stroke

The purpose of this study was to: 1) examine the variation in organizationa l structure within rehabilitation bed-service units (RBU) in the Veterans H ealth Administration (VHA), and 2) evaluate the effects of RBU and parent h ospital structure on stroke rehabilitation outcomes. Two VHA-wide surveys o f acute and rehabilitation services for stroke were linked with 2 y of VHA rehabilitation outcomes for stroke patients. A random effects mixed model w as used to adjust for patient level covariates, control for unique site eff ects, and test for facility level structural effects. After adjusting for p atient covariates, four structural variables were associated with length of stay or patient functional gain. These results indicate that rehabilitatio n structure is important to rehabilitation outcome. The individual variable s identified in this study, namely, diverse multidisciplinary staff, expert physician leadership, staff participation in team care, and richer rehabil itation equipment resources, may represent the distinct aspects of a succes sful, comprehensive rehabilitation unit.