Original Research Time to Inpatient Rehabilitation Hospital Admission and Functional Outcomes of Stroke Patients Hua Wang, PhD, Michelle Camicia, MSN, CRRN, Joe Terdiman, MD, PhD, Yun-Yi Hung, PhD, M. Elizabeth Sandel, MD Objective: To study the association of time to inpatient rehabilitation hospital (IRH) admission and functional outcomes of patients who have had a stroke. Design: A retrospective cohort study. Setting: A regional IRH. Participants: Moderately (n = 614) and severely (n = 1294) impaired patients who had a stroke who were admitted to the facility between 2002 and 2006. Interventions: Not applicable. Main Outcome Measures: Change in total, motor, and cognitive Functional Inde- pendence Measure (FIM) scores between IRH admission and discharge. Results: After controlling for patient demographics and initial medical conditions and functional status, shorter periods from stroke onset to IRH admission were significantly associated with greater functional gains for these patients during IRH hospitalization. Moderately impaired patients achieved a greater total FIM gain when admitted to an IRH within 21 days of stroke. Severely impaired patients showed a gradient relationship between time to IRH admission and total FIM gain, with significantly different functional gain if admitted to an IRH within 30 and 60 days after stroke diagnosis. Results of multiple regression analysis also showed that age, race/ethnicity, side of stroke, history of a previous stroke, functional measures at IRH admission, IRH length of stay, and selected medications were associated with total, motor, and cognitive FIM score changes. In addition, certain factors such as older age, diagnosis of a hemorrhagic stroke or a previous history of stroke, and initial functional status were associated with longer periods between diagnosis and admission to an IRH after the stroke occurred. Conclusions: Our findings are consistent with the hypothesis that earlier transfer to an IRH may lead to better functional improvement after stroke. However, certain factors such as age, race/ethnicity, initial medical conditions and functional status, and length of stay at an IRH contributed to functional gain. Factors affecting the time to IRH admission also were addressed. PM R 2011;3:296-304 INTRODUCTION Demand for postacute care (PAC) for patients who have had a stroke has been increasing, especially given shorter lengths of stay in acute care hospitals during the past few decades. PAC programs and services are those offered within inpatient rehabilitation hospitals (IRHs), skilled nursing facilities, home health care, and outpatient centers. Among all PAC services, IRHs provide the most medically intensive and comprehensive rehabilitation treatment to stroke survivors. In most studies in the literature, investigators support the importance of early transfer of patients who have had a stroke to an IRH. By using time to IRH admission as a continuous variable, Maulden et al [1] and Horn et al [2] found that earlier rehabilitation admission was associated with better functional outcomes in a large cohort of persons who had a stroke. Several investigators suggested a cut-off period to IRH admission for optimal rehabilitation outcomes [3-5]. However, no consensus exists regarding the optimal time frames for IRH admission after a stroke has occurred. In fact, the beneficial effect of early rehabilitation H.W. Kaiser Foundation Rehabilitation Center, 975 Sereno Dr, Vallejo, CA 94589. Address correspondence to: H.W.; e-mail: Hua.Wang@ kp.org Disclosure: 8A, NINDS, Kaiser Permanente M.C. Kaiser Foundation Rehabilitation Center, Vallejo, CA Disclosure: nothing to disclose J.T. Kaiser Permanente Division of Research, Oakland, CA Disclosure: nothing to disclose Y.-Y.H. Kaiser Permanente Division of Re- search, Oakland, CA Disclosure: nothing to disclose M.E.S. Kaiser Foundation Rehabilitation Cen- ter, Vallejo, CA Disclosure: 2B, senior editor of PM&R; 8B, NINDS and NIH Clinical Center (stroke out- comes) The peer reviewers and all others who control content have no relevant financial disclosures. Submitted for publication July 6, 2010; ac- cepted December 31, 2010. PM&R © 2011 by the American Academy of Physical Medicine and Rehabilitation 1934-1482/11/$36.00 Vol. 3, 296-304, April 2011 Printed in U.S.A. DOI: 10.1016/j.pmrj.2010.12.018 296