Advertisement

Association Between Delayed Discharge From Acute Care and Rehabilitation Outcomes and Length of Stay: A Retrospective Cohort Study

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sutherland JM
        • Crump RT.
        Alternative level of care: Canada's hospital beds, the evidence and options.
        Healthc Policy. 2013; 9: 26-34
        • Costa AP
        • Poss JW
        • Peirce T
        • Hirdes JP.
        Acute care inpatients with long-term delayed discharge: evidence from a Canadian health region.
        BMC Health Serv Res. 2012; 12: 1-10
        • Victor CR
        • Healy J
        • Thomas A
        • Seargeant J.
        Older patients and delayed discharge from hospital.
        Health Soc Care Community. 2000; 8: 443-452
        • Bryan K.
        Policies for reducing delayed discharge from hospital.
        Br Med Bull. 2010; 95: 33-46
        • Alcone D
        • Bolda E
        • Leak SC.
        Waiting for placement: an exploratory analysis of determinants of delayed discharges of elderly hospital patients.
        Health Serv Res. 1991; 26: 339-394
      1. Canadian Institute for Health Information. Guidelines to support ALC designation. Available at: https://www.cihi.ca/en/guidelines-to-support-alc-designation. Accessed October 19, 2021.

      2. Canadian Institute for Health Information. Hospital stays in Canada. Available from: https://www.cihi.ca/en/hospital-stays-in-canada. Accessed April 15, 2022.

        • Sumida M
        • Fujimoto M
        • Tokuhiro A
        • Tominaga T
        • Magara A
        • Uchida R.
        Early rehabilitation effect for traumatic spinal cord injury.
        Arch Phys Med Rehabil. 2001; 82: 391-395
        • Munin MC
        • Rudy TE
        • Glynn NW
        • Crossett LS
        • Rubash HE.
        Early inpatient rehabilitation after elective hip and knee arthroplasty.
        JAMA. 1998; 279: 847-852
        • Spettell CM
        • Ellis DW
        • Ross SE
        • et al.
        Time of rehabilitation admission and severity of trauma: effect on brain injury outcome.
        Arch Phys Med Rehabil. 1991; 72: 320-325
        • Heinemann AW
        • Linacre JM
        • Wright BD
        • Hamilton BB
        • Granger C.
        Prediction of rehabilitation outcomes with disability measures.
        Arch Phys Med Rehabil. 1994; 75: 133-143
        • Heinemann AW
        • Hamilton B
        • Linacre JM
        • Wright BD
        • Granger C.
        Functional status and therapeutic intensity during inpatient rehabilitation.
        Am J Phys Med Rehabil. 1995; 74: 315-326
        • Wang H
        • Camicia M
        • Terdiaman J
        • Hung Y
        • Sandel ME.
        Time to inpatient rehabilitation hospital admission and functional outcomes of stroke patients.
        PM R. 2011; 3: 296-304
        • Salter K
        • Jutai J
        • Hartley M
        • et al.
        Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke.
        J Rehabil Med. 2006; 38: 113-117
        • Sirois MJ
        • Lavoie A
        • Dionne CE.
        Impact of transfer delays to rehabilitation in patients with severe trauma.
        Arch Phys Med Rehabil. 2004; 85: 184-191
      3. Canadian Institute for Health Information. CMG+. Available at: https://www.cihi.ca/en/cmg. Accessed August 3, 2021.

        • Linacre JM
        • Heinemann AW
        • Wright BD
        • Granger CV
        • Hamilton BB.
        The structure and stability of the Functional Independence Measure.
        Arch Phys Med Rehabil. 1994; 75: 127-132
        • Wooldridge JM.
        Econometric analysis of cross section and panel data.
        2nd ed. MIT Press, Cambridge, MA2010
        • Newhouse JP
        • McClellan M.
        Econometrics in outcomes research: the use of instrumental variables.
        Annu Rev Public Health. 1998; 19: 17-34
        • Momosaki R
        • Yasunaga H
        • Matsui H
        • Horiguchi H
        • Fushimi K
        • Abo M.
        Effect of early rehabilitation by physical therapists on in-hospital mortality after aspiration pneumonia in the elderly.
        Arch Phys Med Rehabil. 2015; 96: 205-209