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Outcomes for Patients With Stroke in Managed Care vs Fee-for-Service-Reply

Sheldon M. Retchin, MD, MSPH; Shu-Chuan Jennifer Yeh, MS; Randall S. Brown, PhD; Lorenzo Moreno, PhD
JAMA. 1997;278(16):1316. doi:10.1001/jama.1997.03550160036021.
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In Reply.  —Dr Swenson's comments serve to underscore the importance of rehabilitative interventions for those patients with sudden, incapacitating events, such as strokes. Recent data have provided important confirmation that stroke patients who receive care through specialized rehabilitation units or facilities are much more likely to return to an independent lifestyle.1 These units almost always feature multidisciplinary teams led by physiatrists.Dr Feiner offers important suggestions regarding the potential rehabilitative benefits of skilled nursing facilities. His assertion that many skilled nursing facilities offer multidisciplinary approaches to patients frail after stroke may be correct. However, we are skeptical that this routinely compares with the level of rehabilitative therapies offered in more specialized settings (ie, rehabilitation units or hospitals). In fact, the comparison group used in the study by Kramer et al1 included patients who were admitted to both skilled nursing and subacute care settings. Thus, while there are likely some nursing


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