The structure and structural effects of VA rehabilitation bedservice care for stroke.

The purpose of this study was to: 1) examine the variation in organizational structure within rehabilitation bed-service units (RBU) in the Veterans Health Administration (VHA), and 2) evaluate the effects of RBU and parent hospital structure on stroke rehabilitation outcomes. Two VHA-wide surveys of acute and rehabilitation services for stroke were linked with 2 y of VHA rehabilitation outcomes for stroke patients. A random effects mixed model was used to adjust for patient level covariates, control for unique site effects, and test for facility level structural effects. After adjusting for patient covariates, four structural variables were associated with length of stay or patient functional gain. These results indicate that rehabilitation structure is important to rehabilitation outcome. The individual variables identified in this study, namely, diverse multidisciplinary staff, expert physician leadership, staff participation in team care, and richer rehabilitation equipment resources, may represent the distinct aspects of a successful, comprehensive rehabilitation unit.

[1]  K J Ottenbacher,et al.  The results of clinical trials in stroke rehabilitation research. , 1993, Archives of neurology.

[2]  T. Olsen,et al.  Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study. , 1999, Stroke.

[3]  E. Hannan,et al.  Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. , 1998, Pediatrics.

[4]  J. LoGerfo.  Explorations in Quality Assessment and Monitoring. Volume I: The Definitions of Quality and Approaches to its Assessment , 1981 .

[5]  S. Slørdahl,et al.  Treatment in a combined acute and rehabilitation stroke unit: which aspects are most important? , 1999, Stroke.

[6]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[7]  R L Evans,et al.  Multidisciplinary rehabilitation versus medical care: a meta-analysis. , 1995, Social science & medicine.

[8]  S. Slørdahl,et al.  Stroke unit treatment. Long-term effects. , 1997, Stroke.

[9]  O. Rønning,et al.  Stroke units versus general medical wards, I: twelve- and eighteen-month survival: a randomized, controlled trial. , 1998, Stroke.

[10]  B. Hamilton,et al.  Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: accounting for case-mix. , 1998, Archives of physical medicine and rehabilitation.

[11]  P. Langhorne,et al.  Do stroke units save lives? , 1993, The Lancet.

[12]  P. Lyons.  Treatment and rehabilitation. , 1981, Alcohol health and research world.

[13]  S. Slørdahl,et al.  Stroke unit treatment improves long-term quality of life: a randomized controlled trial. , 1998, Stroke.

[14]  P. Duncan,et al.  A taxonomy for classification of stroke rehabilitation services. , 2000, Archives of physical medicine and rehabilitation.

[15]  R. Brook,et al.  Consensus methods: characteristics and guidelines for use. , 1984, American journal of public health.

[16]  A. Kramer,et al.  Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. , 1997, JAMA.

[17]  Harold S. Luft,et al.  Association of volume with outcome of coronary artery bypass graft surgery —scheduled vs nonscheduled operations , 1987, JAMA.