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Vol. 37 No. 4, July/August 2000

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

Dean M. Reker, PhD, RN; Helen Hoenig, MD; Michael A. Zolkewitz, BS; Richard Sloane, MS, MPH; Ronnie D. Horner, PhD; Byron B. Hamilton, MD, PhD; Pamela W. Duncan, PhD, PT

VA Medical Center, Kansas City and the Center on Aging, Kansas University Medical Center, Kansas City, KS.; Health Services Research and Development and Epidemiology Research and Information Center (ERIC), Durham VA Medical Center; Dept of Medicine, Duke University Medical Center; Physical Medicine and Rehabilitation Service, Durham VA Medical Center; Center for the Study on Aging, Duke University Medical Center

Abstract — The purpose of this study was to: 1) examine the variation in organizational structure within rehabilitation bedservice 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.

Key words: outcomes, rehabilitation, stroke, structure

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