Article

This study aimed to determine the predictors of discharge to acute
care after inpatient rehabilitation in severely affected stroke patients.
This was a retrospective study using data from the Uniform Data System for
Medical Rehabilitation (UDSMR) between 2008 and 2009. The main outcome variable
was discharge location, which included discharge to acute care or discharge to
the community after inpatient rehabilitation. The study sample included 223 of
the most severely affected stroke patients (Case-Mix Group 0110 of Medicare
reimbursement classification), of whom 86 were discharged to acute care from
after the inpatient medical rehabilitation setting; 137 similarly classified
stroke patients were discharged to the community after inpatient medical
rehabilitation. The variables examined were Functional Independence Measure
ratings, co-morbid medical conditions, and four groups of stroke-related
neurologic deficits (hemiparesis, dysphagia, language deficits, and other
stroke-related neurologic deficits). The groups were devised based on
International Classification of Diseases, 9th Revision codes. RESULTS: There were
no significant demographic differences between the two groups-those discharged to
the acute care hospital and those discharged to the community. There was a
difference in admission Functional Independence Measure ratings, whereby patients
discharged to acute care were significantly lower (P < 0.05) on admission motor
and cognitive function than were patients discharged to the community. When
controlling for 19 groups of co-morbid medical conditions and 4 groups of
stroke-related neurologic deficits, there was no significant difference between
patients being discharged to an acute care hospital and those discharged to the
community. CONCLUSIONS: In the current study, controlling for impairment
(stroke), severity of condition, demographic variables, inpatient rehabilitation
admission day of the week and discharge day of the week, prehospitalization
living setting, prehospitalization living with (alone, family, other), payer
(secondary insurance coverage), onset days, co-morbid medical conditions, and
classification of stroke-related neurologic deficits, the only variable
predictive of discharge to the acute care hospital from an inpatient
rehabilitation facility is function at admission, mainly the admission motor
Functional Independence Measure rating. If clinicians routinely assess the
functional status of patients during the preadmission screening process, it may
aid in identifying whether the patient is at an increased risk of being
readmitted to the acute care hospital.

Langue : ANGLAIS