Article

OBJECTIVE: Compare 5 comorbidity indices to predict community discharge and
functional status following post-acute rehabilitation.
DESIGN: This was a
retrospective study of Medicare beneficiaries with stroke, lower-extremity
fracture, and joint replacement discharged from inpatient rehabilitation in 2011
(N = 105,275). Community discharge and self-care, mobility, and cognitive
function were compared using the Charlson, Elixhauser, Tier, Functional
Comorbidity, and Hierarchical Condition Category comorbidity indices. RESULTS: Of
the patients, 64.4% were female, and 84.6% were non-Hispanic white. Mean age was
79.3 (SD, 7.5) years. Base regression models including sociodemographic and
clinical variables explained 56.6%, 42.2%, and 23.0% of the variance (R) for
discharge self-care; 47.4%, 30.9%, and 18.6% for mobility; and 62.0%, 55.3%, and
37.3% for cognition across the 3 impairment groups. R values for self-care,
mobility, and cognition increased by 0.2% to 3.3% when the comorbidity indices
were added to the models. The base model C statistics for community discharge
were 0.58 (stroke), 0.61 (fracture), and 0.62 (joint replacement). The C
statistics increased more than 25% with the addition of discharge functional
status to the base model. Adding the comorbidity indices individually to the base
model resulted in C-statistic increases of 1% to 2%. CONCLUSION: Comorbidity
indices were poor predictors of community discharge and functional status in
Medicare beneficiaries receiving inpatient rehabilitation.

Langue : ANGLAIS