A Comparison of Stroke Rehabilitation Functional Outcomes and Cost in Acute Versus Subacute Settings

This quantatative study compares stroke rehabilitation programs in acute and subacute settings. A retrospective chart review was done on twenty Medicare stroke patients in both settings. The patients were discharged to home in the fiscal year October 1997 to September 1998. There were five objectives. The first was determine which setting had higher treatment exposure. The number of units per therapy each patient received determined treatment exposure. The second was to determine if higher functional gain. The third was to determine if higher treatment exposure reduced length of stay. Length of stay was determined from time of admission to rehabilitation to time of discharge from rehabilitation. The fourth was to determine which setting had higher costs. costs were determined by using Medicare charges for therapy units and room rates during the rehabilitation phase. The fifth was to determine if higher costs resulted in better outcomes. Cost was determined by Medicare charges for physical, occupational, speech, and recreational therapies as well as room rates. Acute rehabilitation proved to be better because, while costs per stay were similar in both settings, the acute setting had 33% higher functional gain and three times greater length of stay efficiency