Pamela S Roberts1, Margaret A DiVita2, Richard V Riggs3, Paulette Niewczyk4, Brittany Bergquist5, Carl V Granger6. 1. Department of Rehabilitation, Cedars-Sinai Medical Center, 8631 West Third St, Suite 915 East, Los Angeles, CA 90048(∗). Electronic address: pamela.roberts@cshs.org. 2. Uniform Data System for Medical Rehabilitation, Amherst; and Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY(†). 3. Department of Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA(‡). 4. Uniform Data System for Medical Rehabilitation; and Daemen College, Health Care Studies Department, Amherst, NY(§). 5. Department of Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA(‖). 6. Uniform Data System for Medical Rehabilitation, Amherst, NY(¶).
Abstract
OBJECTIVE: To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PARTICIPANTS: A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. METHODS OR INTERVENTIONS: Logistic regression analysis. MAIN OUTCOME MEASUREMENTS: Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. RESULTS: No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. CONCLUSION: Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting.
OBJECTIVE: To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PARTICIPANTS: A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. METHODS OR INTERVENTIONS: Logistic regression analysis. MAIN OUTCOME MEASUREMENTS: Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. RESULTS: No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. CONCLUSION: Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting.
Authors: Shirley L Shih; Paul Gerrard; Richard Goldstein; Jacqueline Mix; Colleen M Ryan; Paulette Niewczyk; Lewis Kazis; Jaye Hefner; D Clay Ackerly; Ross Zafonte; Jeffrey C Schneider Journal: J Gen Intern Med Date: 2015-05-09 Impact factor: 5.128
Authors: Shirley L Shih; Marisa Flavin; Richard Goldstein; Chloe Slocum; Colleen M Ryan; Aneesh Singhal; Jason Frankel; Ross Zafonte; Jeffrey C Schneider Journal: Am J Phys Med Rehabil Date: 2020-01 Impact factor: 3.412