Comparative Effectiveness of Rehabilitation Services for Survivors of Acute Ischemic Stroke

Study Overview
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Brief Summary
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Retrospective analysis of Get With the Guidelines-Stroke data linked with Medicare claims and the AVAIL longitudinal data sets to assess patterns, predictors, and outcomes associated with the use of rehabilitation services following hospitalization for ischemic stroke. Primary completion defined as the end of primary analyses, consistent with the end of the PCORI Cycle I grant period. Study completion defined as acceptance of final research report and lay abstract by PCORI.

Detailed Description
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The investigators will seek to answer three questions: What are the person- and system-level factors associated with use of rehabilitation services following acute ischemic stroke? Among stroke survivors discharged to short-term inpatient rehabilitation, are high-intensity services performed at an Inpatient Rehabilitation Facility (IRF) more effective than lower intensity services performed at a Skilled Nursing Facility (SNF), at improving patient outcomes at 3 and 12 months? Among stroke survivors discharged home, is early follow-up with a physician more effective than follow-up after 7 days at 3 and 12 months?

Official Title
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Comparative Effectiveness of Rehabilitation Services for Survivors of Acute Ischemic Stroke

Conditions
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Ischemic Stroke

Intervention / Treatment
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* Other: retrospective analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: acute ischemic stroke within the Get With the Guidelines-Stroke data set for 2006-2008, and successfully linked to Medicare claims through 2009 Exclusion Criteria: death during index hospitalization
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: retrospective analysis|Analysis of data for patients hospitalized in 2006-2008 with acute ischemic stroke, and successfully linked with Medicare claims through 2009|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Receiving Inpatient, Home, or Community Based Rehabilitation Services | Received either inpatient care in an inpatient rehabilitation or skilled nursing facility, or home or community-based rehabilitation. | discharge through 90 days | 
| Home-time | Number of days alive and living outside of inpatient care | 12 months post-discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Who Were Functionally Dependent or Dead 12 Months After Hospital Discharge | 12-month functional status as measured by modified Rankin scale scores ranging between 0 (no symptoms) and 6 (death), among patients discharged to inpatient rehabilitation or skilled nursing facility. Outcome measure reports number of participants with Rankin score of 3-6. The outcome was not assessed among patients discharged home. | 12 months post-discharge | 
| Quality of Life (QOL) | EuroQOL-5 Dimensions (EQ-5D) to assess health-related quality of life by asking and scoring the level of severity (1 = no problems, 2 = some problems, 3 = extreme problems) in 5 dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Score for each question is added together to provide total score, which is converted to provide a range from 1 (maximum and highest health state for quality of life) down to 0 (lowest health state and quality of life). | 12 months post-discharge | 
| Number of Participants Who Were Institutionalized in a Nursing Home for Long-term Care Within 12 Months of Hospital Discharge. | Institutionalization (primary living location in a nursing home for long-term care and not for rehabilitation or short-term skilled stay) as measured by patient or proxy family member report on 12-month follow-up phone call. | 12 months post-discharge | 
| Number of Participants Who Were Rehospitalized or Died Within 12 Months of Stroke Hospitalization. | All-cause rehospitalization or death within 12 months of index stroke hospitalization as indicated in Medicare claims files. | 12 months post-discharge | 
| Number of Participants Who Died Within 12 Months of Stroke Hospitalization | Death within 12 months of discharge from index stroke hospitalization as indicated in Medicare claims files | 12 months post-discharge |