Inpatient Rehabilitation Outcomes for Patients with Debility
Galloway, Rebecca 1977-
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Background: Inpatient rehabilitation facility (IRF) goals are to optimize functional independence and discharge patients to community living. Debility, or deconditioning associated with hospitalization, is the fourth most common impairment group, accounting for about 10% of IRF cases. Objectives were to provide benchmark data for patients with debility, consider trends with respect to health care policy changes, identify risk factors for discharge to acute or subacute care, and examine readmission to acute care after discharge to community. Aim 1: National benchmark data for years 2000 – 2010 were retrospectively analyzed for 260,373 patients from 830 IRFs contributing to the Uniform Data System for Medical Rehabilitation. Trends from 2000 to 2010 included decrease in mean (SD) FIM® instrument (“FIM”) total admission ratings from 73.9 (16.2) to 62.5 (15.8). FIM total discharge ratings decreased from 95.0 (19.7) in 2000 to 88.2 (19.8) in 2010. Mean length of stay decreased from 14.3 (9.1) in 2000 to 12.1 (6.2) days in 2010. FIM efficiency increased from 1.9 (1.7) in 2000 to 2.4 (1.9) in 2010. Discharge to community decreased from 80% in 2000 to 75% in 2010. Health policy changes may have influenced trends. Aims 2 & 3: Centers for Medicare and Medicaid Services data (years 2006 to 2009) were analyzed for factors associated with discharge to acute or subacute care (N = 67,626) and readmissions for 90 days following discharge (N = 45,424). Discharge setting was 76% community, 13% subacute, and 11% acute care. Significant risk factors for both acute and subacute discharge settings were lower FIM motor subscale, male gender, living alone, comorbidity tier, weight loss, and fluid/electrolyte disorders. Rehospitalization rates were 19% at 30 days and 34% at 90 days. Congestive heart failure, renal failure, and chronic pulmonary disease were common causes of hospital readmission and independent risk factors for reshospitalization. Conclusions: National data indicate the number of debility cases is increasing with diverse etiologic diagnoses. A high proportion of patients discharged to acute or subacute care. One-third of patients who discharged to the community experienced acute hospital readmission within 90 days. Functional independence is an important indicator for discharge setting and rehospitalization.