Objectives: To determine what predicts the setting (hospital- versus home-based) of outpatient therapy services provided to stroke rehabilitation inpatients. To assess the relationship between type of outpatient program attended and Functional Independence Measure (FIM) change. 

Methods: This study was a retrospective chart review. Stroke patients admitted to an inpatient rehabilitation unit between January 1, 2009 and March 1, 2016 who subsequently participated in either the home-based or hospital-based outpatient therapy program were included. Data was collected from the National Rehabilitation Reporting System and each outpatient program’s administrative dataset. Linear and logistic regression were used to compare receiving home versus hospital outpatient therapy. 

Results: In total, 360 and 361 inpatients attended the hospital and home-based programs, respectively. Those attending the hospital-based outpatient program were significantly younger, lived closer to the hospital, had shorter inpatient lengths of stay and had higher inpatient FIM scores at both admission and discharge. Compared to the hospital-based program, patients attending the home-based program had significantly greater mean FIM change during outpatient therapy (6.9±8.5 versus 4.4±6.8, p=0.001) and a shorter median outpatient length of stay (71.0, IQR=59.0-100.0 versus 75.5, IQR=61.8-121.8, p=0.334). Those in the hospital-based program received a greater number of therapy visits than those in the home-based program (41.2±31.7 versus 32.5±19.3, respectively; p=0.005). 

Conclusion: Identifying the pathways to integrated, high-quality and efficient stroke care is necessary for optimizing health outcomes for patients. Patients receiving either hospital- or home-based therapy made significant gains as measured using the FIM, with the latter group demonstrating modestly greater gains.

A COMPARISON OF HOME-BASED AND HOSPITAL-BASED OUTPATIENT REHABILITATION SERVICES IN ONTARIO, CANADA