Patient-Reported Continuity of Care and Functional Safety Concerns After Inpatient Cancer Rehabilitation

Abstract

Background. Patients with cancer have been noted to have inadequate continuity of care after discharge from hospital. We sought to assess patient-reported continuity of care and functional safety concerns after acute inpatient rehabilitation. Methods. This was a prospective study that used crosssectional surveys at a National Cancer Institute Comprehensive Cancer Center. All patients who were admitted to acute inpatient rehabilitation from September 5, 2018, to February 7, 2020, met the inclusion criteria, and completed two surveys (assessing continuity of care and functional safety concerns) upon discharge and 1 month after discharge were included in the study. Results. A total of 198 patients completed the study, and no major concerns were reported by the patients. The greatest concern was a lack of adequate communication management among different providers, reported by only 10 (5.0%) patients. The combined fall and near-fall rate within 1 month after discharge was (25/198) 13%. Brain metastasis, a comorbidity of depression, and a history of falls were significantly associated with a higher risk of falls or near falls within 1 month after discharge. Conclusion. Although overall patients with cancer reported adequate continuity of care and feeling safe to function at home after acute inpatient rehabilitation, it is important to be aware that fall or near-fall events within 1 month after acute inpatient rehabilitation are associated with brain metastasis, comorbidity of depression, and a history of falls. Thus, patients with these risk factors may benefit from including more focused fall prevention education and interventions. The Oncologist 2021;26:1-10 Implications for Practice: Patients with cancer often have extensive problems that require care from multiple health care providers simultaneously, and a high level of coordination is needed for adequate transition of care from the inpatient to the outpatient setting. This transition of care period is prone to inadequate continuity of care and, for older adults, a particular risk for falls. Assessment for risk of fall is also an important factor to consider when evaluating patients to continue oncology treatments. There is a gap in knowledge regarding patient-reported continuity of care and functional safety concerns after acute inpatient cancer rehabilitation.

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit

“…41 When translating this to posthospital discharge falls, our previous safety survey study showed that of 198 patients who responded to the survey and had been admitted to IPR from 2018 to 2020, 5% fell inpatient and 9% fell within 30 days of discharge. 25 All (100%) of these patients were prescribed to continue rehabilitation in their community upon discharge. This is a standard practice because continuing rehabilitation in the community setting helps the patients maintain the progress they made during their inpatient stay and to address any ongoing issues or challenges they may face during the recovery process.…”

“…We showed that brain metastases, comorbid depression, and a history of falls were significantly associated with a higher risk of falls within 1 month of discharge, which is similar to another outpatient falls study in elderly patients with cancer, which showed that fall history, male sex, cognitive impairment, depression, dependency for ADLs, fear of falling, and use of professional home care contribute to fall risk within the first 3 months of enrollment in the study. 25,44 Previous studies showed that a one-point increase in total FIM score is correlated with either 2.19 (patients with traumatic brain injury patients) or 3-5 (patients with spinal cord injury) fewer minutes of caregiver help per day. 45,46 By undergoing IPR in our study, patients would be able to decrease caregiver burden by 13-30 minutes a day.…”

“…[21][22][23][24] One study incidentally found an inpatient fall rate of 5% among inpatient cancer rehabilitation patients, but this study had a selective cohort of patients who consented to participate in a safety survey study upon hospital discharge. 25 There are no studies to our knowledge documenting the frequency of falls and characteristics of fallers admitted to a cancer hospital's IPR unit, which is our primary objective. On the basis of previous studies, we expected that older age, a cognitive impairment, and lower admission FIM scores would be characteristics that will increase the risk of falls.…”

“…21-24 One study incidentally found an inpatient fall rate of 5% among inpatient cancer rehabilitation patients, but this study had a selective cohort of patients who consented to participate in a safety survey study upon hospital discharge. 25…”

Thirty‐day hospital readmission rate, reasons, and risk factors after acute inpatient cancer rehabilitation

“…All consecutive patients who were admitted to acute inpatient rehabilitation service from within our hospital between September 5, 2018 and February 7, 2020 were screened for eligibility for a survey study assessing continuity of care and functional safety concerns upon discharge (first survey) and 1 month after discharge (second survey). 30 For this study, a secondary retrospective analysis was performed using data for all patients who participated in the survey study. Thus, the following inclusion criteria were used: patients had to (a) have been discharged from the acute cancer inpatient rehabilitation unit to their home setting; (b) provide informed consent; (c) be 18 years of age or older; and (d) be English-speaking.…”