Abstract
Objective
To examine the association between discharge delays from acute to rehabilitation care
because of capacity strain in the rehabilitation units, patient length of stay (LOS),
and functional outcomes in rehabilitation.
Design
Retrospective cohort study using an instrumental variable to remove potential biases
because of unobserved patient characteristics.
Setting
Two campuses of a hospital network providing inpatient acute and rehabilitation care.
Participants
Patients admitted to and discharged from acute care categories of Medicine and Neurology/Musculoskeletal
(Neuro/MSK) and subsequently admitted to and discharged from inpatient rehabilitation
between 2013 and 2019 (N=10486).
Interventions
None.
Main Outcome Measures
Rehabilitation LOS, FIM scores at admission and discharge, and rehabilitation efficiency
defined as FIM score improvement per day of rehabilitation.
Results
The final cohort contained 3690 records for Medicine and 1733 for Neuro/MSK categories.
For Medicine, 1 additional day of delayed discharge was associated with an average
5.1% (95% confidence interval [CI], 3%-7.3%) increase in rehabilitation LOS and 0.08
(95% CI, 0.03-0.13) reduction in rehabilitation efficiency. For Neuro/MSK, 1 additional
day of delayed discharge was associated with an average 11.6% (95% CI, 2.8%-20.4%)
increase in rehabilitation LOS and 0.08 (95% CI, −0.07 to 0.23) reduction in rehabilitation
efficiency.
Conclusions
Delayed discharge from acute care to rehabilitation because of capacity strain in
rehabilitation had a strong association with prolonged LOS in rehabilitation. An important
policy implication of this “cascading” effect of delays is that reducing capacity
strain in rehabilitation could be highly effective in reducing discharge delays from
acute care and improving rehabilitation efficiency.
Keywords
List of abbreviations:
ALC (alternative level of care), CI (confidence interval), HTSD (high-tolerance short-duration), IV (instrumental variable), LOS (length of stay), Neuro/MSK (Neurology/Musculoskeletal), OLS (ordinary least squares), RIW (resource intensity weight)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 24, 2022
Accepted:
May 18,
2022
Received in revised form:
May 11,
2022
Received:
January 18,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The work of Vahid Sarhangian was partially supported by a grant from the Natural Sciences and Engineering Research Council of Canada (NSERC) (grant no. RGPIN-2018-04518) and a Connaught New Researcher award. The work of Jing Dong was partially supported by a National Science Foundation CAREER Award (grant no. 1994209).
Disclosures: none
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
