1. Rehabilitation and Regenerative Medicine Physiatrist Referral Patterns for Post Acute Stroke Rehabilitation David J Cormier DO, DPT Megan A Frantz MD Ethan Rand MD Joel Stein MD

2. Rehabilitation and Regenerative Medicine Disclosures None

3. Rehabilitation and Regenerative Medicine Objective Examining variation in physiatrist referral patterns for post-acute rehabilitation for stroke patients

4. Rehabilitation and Regenerative Medicine Design A cross-sectional survey study -five fictional case vignettes -medical, social, and functional domains Physiatrists -American Academy of Physical Medicine and Rehabilitation Annual Assembly -(November 13-16, 2014; San Diego, CA) 86 surveys were collected over a 3-day period

5. Rehabilitation and Regenerative Medicine Demographics Gender Race/Ethnicity

6. Rehabilitation and Regenerative Medicine Regions Geographic Area Area of Practice

7. Rehabilitation and Regenerative Medicine Type of Practice Treats Stroke PatientsAffiliation

8. Rehabilitation and Regenerative Medicine Where do you practice?

9. Rehabilitation and Regenerative Medicine Age Yrs in Practice Level of Training

10. Rehabilitation and Regenerative Medicine Case One Mr. Jones is a 64 year old man, working full­time as an attorney, lives with wife in a ranch style single­family home. He sustained a Left internal capsule stroke with right hemiparesis arm>leg. Needs moderate assistance with ADL’s and moderate assistance to walk a few steps. His Cognition, language, swallowing are intact. PMH: Hypertension, Type II Diabetes, Coronary Artery Disease, s/p cardiac stents x 2.

11. Rehabilitation and Regenerative Medicine Case Two Mr. Smith is an 83 year old man with prior stroke, lives alone, homebound prior to admission, with 24 x 7 home health aide, poor short­term memory prior to stroke. He sustained a large Left MCA infarct with global aphasia, dysphagia requiring g­tube, and right hemiplegia. Dependent for ADL’s and transfers.

12. Rehabilitation and Regenerative Medicine Case Three Ms. Doe is a 42 year old woman, accountant, married, with 3 school age children. She sustained a brainstem hemorrhage from AVM with severe dysphagia, requiring g­ tube, tracheostomy tube (now capped), severe dysarthria, hemiplegic on the left, and hemiparetic on the right side. She is Dependent for ADL’s and transfers. She is Alert and cognitively intact.

13. Rehabilitation and Regenerative Medicine Case Four Ms. Johnson is a 70 year old woman, lives with husband in accessible apartment, both recently retired. She sustained a Right subcortical stroke with left hemiparesis affecting arm>leg. She is able to walk 25 feet with minimal assistance from therapist, and needs minimal assistance with dressing and bathing. She has normal cognition, speech, swallowing. PMH: Hypertension, newly diagnosed atrial fibrillation, now well controlled with warfarin and beta­blocker.

14. Rehabilitation and Regenerative Medicine Case Five Ms. Thompson is an 86 year old woman, widowed, lives alone in an apartment in an elevator building. Was active prior to stroke as volunteer in hospital. No children and with limited financial resources. She sustained a Left MCA stroke with right hemiplegia, moderate expressive aphasia but with relative sparing of comprehension, dysphagia with g­tube in place. Dependent for ADL’s, max assist for transfers. She has newly diagnosed atrial fibrillation, rate well controlled, on Coumadin for secondary stroke prevention.

15. Rehabilitation and Regenerative Medicine Results

16. Rehabilitation and Regenerative Medicine Factors Influencing Post-Acute Facility Selection - Physiatrists

17. Rehabilitation and Regenerative Medicine Factors Influencing Post-Acute Facility Selection – Case Managers Sicklick et al Northeast Cerebrovascular consortium rehabilitation and recovery work group 2014.

18. Rehabilitation and Regenerative Medicine How frequently does the speed with which you are able to help arrange discharge for a stroke patient impact his or her final destination? PhysiatristCase Managers Sicklick et al Northeast Cerebrovascular consortium rehabilitation and recovery work group 2014.

19. Rehabilitation and Regenerative Medicine Results Bivariate analysis (using chi-square) -No statistically significant relationship between any of the demographic variables and post-stroke rehabilitation preference for any of the cases The highest mean influence ratings -Prognosis for functional outcome (8.63) -Quality of post-acute facility (8.31) The lowest mean influence ratings -location of post-acute facility (5.74) -Insurance (5.76)

20. Rehabilitation and Regenerative Medicine Conclusion Physiatrists show a preference for inpatient rehabilitation facilities Physiatrists’ referral patterns did not vary with any identified practitioner variables or geographic region Referral patterns varied by case