Results Summary

What was the research about?

After a stroke, patients can go from the hospital to either a rehabilitation, or rehab, center or a skilled nursing center until they are ready to go home. Rehab centers provide more hours of daily therapy than skilled nursing centers. Stroke patients may also go straight home from the hospital. Patients and their doctors need to choose the right place for patients to recover.

In this study, the research team wanted to learn if stroke patients recovered better at rehab centers or skilled nursing centers. The team also compared patients who went straight home from the hospital and saw a doctor within a week with those who waited longer to see a doctor.

What were the results?

After leaving the hospital, 22 percent went to a rehab center, 25 percent went to a skilled nursing center, and 44 percent of patients went straight home.

In the first year after a stroke, patients who went to a rehab center were more likely to recover better than patients who went to a skilled nursing center. Compared with patients who went to a skilled nursing center, those who went to a rehab center

  • Were more likely to live for at least one year
  • Spent more days at home
  • Were less likely to go back to the hospital
  • Were less likely to move into a nursing home

Among patients who went straight home, the team didn’t find differences between those who saw a doctor within a week and those who had a later follow-up visit.

Who was in the study?

The research team looked at medical records and insurance claims for 162,432 people who had a stroke between 2006 and 2008. Of these, 55 percent of rehab center patients and 62 percent of skilled nursing center patients had a stroke of at least moderate severity. All patients had Medicare. They received care at one of 1,192 hospitals taking part in a large national stroke registry.

What did the research team do?

The research team looked at

  • How severe the patients’ strokes were
  • If they had other health problems
  • Where patients went and what care they had after they left the hospital
  • How many patients died in the year after their stroke
  • If patients went back to the hospital

An advisory group of patients and health professionals helped design the study and analyze the data.

What were the limits of the study?

The study included people ages 65 and older who went to hospitals that were part of a national stroke registry. Results may be different for people younger than 65 or who receive care at other hospitals.

Future research could look at how getting care at more than one type of center after a stroke affects patients’ health.

How can people use the results?

Patients and their doctors could use the results of this study to help decide where to recover from a stroke when patients leave the hospital but aren’t ready for home care.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, the PI made changes including

  • Providing a detailed description of stakeholder engagement in the development and implementation of the research study, but also noting that the description might look like less engagement than typically seen in prospective studies because of the retrospective design of the research (which means that the data exist before the study is designed, which provides fewer opportunities for stakeholder input and participation).
  • Responding to reviewer requests to identify which of their three analyses were considered primary, since the results of the three analyses differed. The researchers explained that although the report describes the rationale for using instrumental variables in the analyses, the study stakeholders and advisory committee were unable to reach agreement about which instrumental variable approach to use. The researchers added additional discussion of the strengths and limitations of the two instrumental variables used in these analyses, to provide a clearer understanding of the findings.
  • Confirming that the authors decided which subgroup analyses and multivariate risk models to use during the course of the study rather than pre-specifying them.
  • Providing a rationale, in response to reviewers’ requests, for the use of simple imputation to model missing data rather than multiple imputation.
  • Adding a paragraph and table of results to describe the adjusted comparative findings of Aim 3, in response to reviewers’ comments that the findings were not adequately reported in the Results section. The researchers also added comments about the Aim 3 results to the Limitations section.

Conflict of Interest Disclosures

Project Information

Janet Prvu Bettger, ScD
Duke University
Comparative Effectiveness of Rehabilitation Services for Survivors of an Acute Ischemic Stroke

Key Dates

December 2012
May 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 20, 2023