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Objective. —To assess whether outcomes and costs differ for elderly patients admitted to rehabilitation hospitals, subacute nursing homes, and traditional nursing homes. Design. —Inception cohort stratified by provider type and followed prospectively for 6 months. Setting. —A total of 92 hospital-based units and freestanding facilities from 17 states. Patients. —A total of 518 randomly selected patients with hip fracture and 485 stroke patients admitted from November 1991 to February 1994. Main Outcome Measures. —At 6 months comparing community residence, recovery to premorbid levels in 5 activities of daily living (ADLs), Medicare costs, and the number of therapy and physician visits. Outcomes were adjusted for premorbid residence and function, caregiver availability, comorbid illness, admission function, cognition, depression, sensory deficits, and mobility impairments. Results. —On admission, rehabilitation hospital patients were more likely (PPP=.03 for stroke and.009 for hip fracture) than for traditional nursing home patients. Conclusions. —Study findings are consistent with enhanced outcomes for elderly patients with stroke treated in rehabilitation hospitals but not for patients with hip fracture. Subacute nursing homes were more effective than traditional nursing homes in returning patients with stroke to the community, despite comparable functional outcomes.
Andrew M. Kramer (Wed,) studied this question.