Amount of Post-acute and Outpatient Rehabilitation for Older Adults in the 6-months After Stroke: A National Retrospective Evaluation in the Veterans Health Administration 1061

This presentation will feature results from a national restrospective evaluation of post-acute and outpatient rehabilitation use among older adults post-stroke. The study included all Veterans who were at least 65 years of age, hospitalized for a stroke between January 1, 2017 to December 31, 2021. We used VA and VA-linked Medicare datato identify initial discharge location and all post-acute rehabilitation care. Post-acute rehabilitation comprised all rehabilitation received in an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH). Trends in the proportion of patients initially discharged to either an IRF, SNF, HH, or home without HH per year were examined using a Cochran-Mantel-Haenszel Test. We fit a generalized negative binomial model with an offset term for time to examine patient and clinical factors that were associated with a higher rate of rehabilitation use per month of follow-up. The primary outcome was total amount of rehabilitation received over the first 180 days post-stroke. This was defined as a composite score of length of stay (in days) for post-acute rehabilitation and number of outpatient physical and occupational therapy visits. The final cohort comprised 161,377 hospital admissions for 133,420 unique Veterans. Sixty-five percent received at least one type of post-acute rehabilitation but only 33% received outpatient rehabilitation. The median [min, max] composite score for amount of rehabilitation was 21 [0,1090], with the highest amount of rehabilitation observed among those who discharged to an IRF following acute hospitalization (57 [0,716]) and SNF (53 [0,1090]). Of the 33% receiving outpatient therapy, the median number of physical and occupational therapy visits was 6 and 2, respectively). The amount of rehabilitation received by older Veterans in the first 180 days post-stroke is low. Only 33% of the sample received outpatient therapy. The amount of rehabilitation was associated with age, stroke type, and marital status.