Abstract
Among 100 Medicare stroke patients in 1980 and 100 stroke patients in 1985 who were transferred to a rehabilitation center, no differences were found in type of stroke, comorbidity, functional level at admission and discharge, or length of stay. Time from onset of stroke to time of transfer to the rehabilitation service decreased significantly, and the number of neuromedical complications within 24 h of the transfer of patients from other acute care hospitals rose significantly from 22 to 48%. Subsequently, about 40% of patients in each period developed medical complications of their stroke or comorbid conditions that led to a temporary acute hospital transfer, ongoing manipulation of medication and biochemical monitoring, or modification of rehabilitation therapies. More intensive neuromedical care of patients transferred into rehabilitation centers may be needed under the pressures for early acute hospital discharge fostered by the diagnostic related groups system.