Postacute Care Setting, Facility Characteristics, and Poststroke Outcomes: A Systematic Review.

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Gerontology

Background:

• Post-stroke care settings significantly impact patient recovery and long-term health.
• Skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) offer distinct post-acute care environments.
• Understanding comparative effectiveness is crucial for optimizing stroke patient rehabilitation.

Purpose of the Study:

• To synthesize existing research comparing post-stroke health outcomes between SNFs and IRFs.
• To evaluate the relationship between facility characteristics and patient outcomes in these settings.

Main Methods:

• Comprehensive literature search of PubMed and CINAHL databases (1998-2016).
• Inclusion of observational and experimental studies comparing IRF and SNF rehabilitation for adult stroke patients.
• Exclusion of non-peer-reviewed, single-center, descriptive, and non-US studies.

Main Results:

• Inpatient rehabilitation facilities (IRFs) demonstrated superior outcomes in community discharge, readmission prediction, and all-cause mortality compared to skilled nursing facilities (SNFs).
• Functional status outcomes were inconsistent between the two settings.
• No studies assessed quality of life, and IRFs incurred higher costs.

Conclusions:

• Available evidence suggests inpatient rehabilitation facilities (IRFs) offer better post-stroke outcomes than skilled nursing facilities (SNFs), albeit with increased costs.
• Further research is essential to elucidate the impact of post-acute care settings and facility attributes on health outcomes.
• Findings can inform future reimbursement system reforms and clinical practice guidelines.