Journal of Rehabilitation Research & Development (JRRD)

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Volume 47 Number 5, 2010
   Pages 431 — 440

Abstract —  Cost differences in VHA acute and subacute rehabilitation units: Implications for VHA resource planning

W. Bruce Vogel, PhD;1-2 Tracey E. Barnett, PhD;1,3* Dean Reker, PhD4

1Research Health Scientist, Veterans Health Administration (VHA) Rehabilitation Outcomes Research Enhancement Award Program, Gainesville, FL; 2Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL; 3Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL; 4VHA Information Resource Center, Chicago, IL; and Department of Veterans Affairs Medical Center, Kansas City, KS

Abstract — Within the Veterans Health Administration (VHA), the top tier of postacute rehabilitation care is provided in acute rehabilitation bedservice units (ARBUs). The next level of care is provided in subacute rehabilitation bedservice units (SRBUs). We fitted reduced-form and structural models to explain VHA cost differences between ARBUs and SRBUs across time and for the individual cost components. We included sociodemographic variables, time since stroke onset, care facility, and the Functional Independence Measure at admission as explanatory variables. The multivariable results indicate that total index stay costs are lower in ARBUs by almost $6,000 (or approximately 25%) compared with SRBUs. Moreover, the lower costs observed in ARBUs in this study combined with the higher rates of guideline compliance and improved outcomes in ARBUs found in previous work suggest that stroke rehabilitation in an ARBU may be more cost-effective than stroke rehabilitation in an SRBU.

Key words: acute units/subacute units, cost, functional status, guidelines, lengths of stay, outcomes, planning, rehabilitation, stroke, VHA.

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Last Reviewed or Updated  Thursday, July 29, 2010 8:07 AM

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