Length of Stay in Rehabilitation is Associated with Admission Neurologic Deficit and Discharge Destination

Elwood, Douglas; Rashbaum, Ira G.; Bonder, Jaclyn; Pantel, Austin R.; Berliner, Jeffrey; Yoon, Steve; Purvin, Mike; Ben-Roohi, Moshe; Bansal, Amit

doi:10.1016/j.pmrj.2008.10.010

Cited by 31 publications

(26 citation statements)

References 24 publications

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“…Patients with pLOS had significantly worse outcomes in nearly every measure. Of nonmodifiable risk factors, patients with pLOS had more severe neurologic dysfunction at baseline and were older than patients who did not experience pLOS, in keeping with previous reports [1, 3–5, 14]. Of modifiable risk factors, nonneurologic medical complications had the strongest association with pLOS.…”

Section: Discussionsupporting

confidence: 89%

Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay

et al. 2013

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IntroductionProlonged length of stay (pLOS) following ischemic stroke inflates cost, increases risk for hospital-acquired complications, and has been associated with worse prognosis.MethodsAcute ischemic stroke patients admitted between July 2008 and December 2010 were retrospectively analyzed for pLOS, defined as a patient stable for discharge hospitalized for an additional ≥24 hours.ResultsOf 274 patients included, 106 (38.7%) had pLOS (median age 65 years, 60.6% female, 69.0% black). Patients with pLOS had higher admission NIHSS than patients without pLOS (9 versus 5, P = 0.0010). A larger proportion of patients with pLOS developed an infection (P < 0.0001), and after adjusting for covariates, these patients had greater odds of poor short-term functional outcome (OR = 2.25, 95% CI 1.17–4.32, P = 0.0148). Adjusting for infection, the odds of patients with pLOS having poor short-term functional outcome were no longer significant (OR = 1.68, 95% CI 0.83–3.35, P = 0.1443).ConclusionsThe contraction of a hospital-acquired infection was a significant predictor of pLOS and a contributor of poor short-term outcome following an ischemic stroke. Whether the cause or the consequence of pLOS, hospital-acquired infections are largely preventable and a target for reducing length of stay.

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Section: Discussionsupporting

confidence: 89%

Hospital-Acquired Infection Underlies Poor Functional Outcome in Patients with Prolonged Length of Stay

et al. 2013

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“…IRF LOS contributes directly to the poststroke care cost. Studies have reported that patient severity (Appelros, ; Elwood et al., ; Harvey et al., ), negative symptoms (Galynker et al., ), medical complications (Saxena et al., ), and functional status at IRF admission (Brock et al., ; Franchignoni et al., ; Harvey et al., ; Stillman, Granger, & Niewczyk, ; Tan, Heng et al., ) are the major determinants of IRF LOS. Some other nonmedical patient characteristics and organization factors are associated with duration of IRF stay.…”

Section: Discussionmentioning

confidence: 99%

“…They observed that after controlling for functional status at IRF admission and other covariates, a longer IRF LOS was associated with a higher Functional Independence Measure (FIM) total at IRF discharge ( p < .0001) but less likelihood to be discharged to the community (OR = 0.997, 95% CI = 0.994–0.999). In addition to medical conditions (Appelros, ; Elwood et al., ; Galynker et al., ; Harvey et al., ; Saxena, Koh, Ng, Fong, & Yong, ) and functional status at IRF admission (Brock et al., ; Franchignoni, Tesio, Martino, Benevolo, & Castagna, ; Harvey et al., ; Tan, Heng, Chua, & Chan, ; Stillman et al., ), other patient characteristics and nonmedical factors influence the duration of IRF stay, including patients’ socioeconomic status and family structure (Tan, Heng et al., ), caregiver characteristics and IRF discharge planning program (Tan, Chong, Chua, Heng & Chan, ), and incentives for cost containment and support inpatients’ home environments (Stineman et al., ).…”

Section: Introductionmentioning

confidence: 99%

Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

Camicia

Wang

DiVita

et al. 2016

Rehabilitation Nursing

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Purpose: To examine the association of inpatient rehabilitation facility (IRF) length of stay (LOS) with stroke patient outcomes. Design: A secondary data analysis of the Uniform Data System for Medical Rehabilitation database. Methods: Stroke patients discharged from IRFs in the United States between 2009 and 2011 were identified and divided into mild (n = 639), moderate (n = 2,065), and severely (n = 2,077) impaired groups. Study outcomes included cognition and motor functional gains measured by the Functional Independence Measure (FIM) instrument and discharge to the community. Findings: The average LOS was 8.9, 13.9, and 22.2 days for mild, moderate, and severely impaired stroke patients, respectively. After controlling for FIM admission and other important covariates, a longer LOS was associated with a modest increase in cognition gain (b = 0.038, p = .0045) for the moderately impaired patients, and a modest increase in cognition (b = 0.13, p < .0001) and motor gains (b = 0.25, p < .0001) as well as a tendency for discharge to the community (OR = 1.01, 95% CI = 1.00-1.02) among the severely impaired patients. However, a longer LOS showed a negative association with functional gains among the mildly impaired patients as well as discharge to community for both mild and moderately impaired patients. Conclusion: The association of IRF LOS and patient outcomes varied by stroke impairment severity, positively for more severely impaired patients and negatively for mildly impaired patients. Clinical Relevance: The study provides evidence for the care of stroke patients at the IRF setting.

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“…Studies have revealed the importance of discharge destination (17,18) (particularly to community hospitals and nursing homes) and adequacy of care by caregivers following discharge in determining the duration of the patient's hospital stay. In particular, the availability of caregiver assistance and support, (19) presence of dementia (20) and admission to intermediate and long-term care (ILTC) services (21) have emerged as the most significant factors.…”

Section: Introductionmentioning

confidence: 99%