IRB Number


Date of Award

Spring 1-2024

Document Type


Degree Name

Doctor of Education (EdD)

First Advisor

Marilyn E. Miller, P.T., Ph.D.

Second Advisor

Miguel Garcia, P.T., D.P.T., Ed.D.

Third Advisor

Sunddip Aguilar, Ed.D.


Discharge delays present hospitals with challenges in managing costs for Medicare admissions. Meanwhile, Inpatient Rehabilitation Facilities (IRF) are subject to strict pre-admission requirements that can complicate efficient transitions of care for patients with intensive rehabilitation needs. The purpose of this retrospective quantitative correlational study was to examine any relationship between acute care discharge delays and IRF utilization. This study investigated whether length of stay (LOS) and Medicare Advantage prior authorization requirements impact IRF referrals by reviewing 3,747 medical records of acute stroke patients aged 65 years and older at a regionally integrated healthcare system over a 3-year period (2020- 2022). Referral to IRF was strongly correlated with LOS, and Medicare financial class (fee-for-service vs. Medicare Advantage) was a significant moderator of that relationship. Patient age at admission and whether the referring hospital operated an IRF were also significantly related to IRF referral. Further, distinct differences in post-acute care pathways were noted for stroke patients between FFS and MA plans despite very similar clinical profiles.