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Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

Camicia, Michelle MSN, CRRN, CCM1; Wang, Hua PhD1; DiVita, Margaret PhD, MS2; Mix, Jacqueline MPH3; Niewczyk, Paulette PhD, MPH3

doi: 10.1002/rnj.218
Feature: CE ARTICLES
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Purpose: To examine the association of inpatient rehabilitation facility (IRF) length of stay (LOS) with stroke patient outcomes.

Design: A secondary data analysis of the Uniform Data System for Medical Rehabilitation database.

Methods: Stroke patients discharged from IRFs in the United States between 2009 and 2011 were identified and divided into mild (n = 639), moderate (n = 2,065), and severely (n = 2,077) impaired groups. Study outcomes included cognition and motor functional gains measured by the Functional Independence Measure (FIM) instrument and discharge to the community.

Findings: The average LOS was 8.9, 13.9, and 22.2 days for mild, moderate, and severely impaired stroke patients, respectively. After controlling for FIM admission and other important covariates, a longer LOS was associated with a modest increase in cognition gain (β = 0.038, p = .0045) for the moderately impaired patients, and a modest increase in cognition (β = 0.13, p < .0001) and motor gains (β = 0.25, p < .0001) as well as a tendency for discharge to the community (OR = 1.01, 95% CI = 1.00–1.02) among the severely impaired patients. However, a longer LOS showed a negative association with functional gains among the mildly impaired patients as well as discharge to community for both mild and moderately impaired patients.

Conclusion: The association of IRF LOS and patient outcomes varied by stroke impairment severity, positively for more severely impaired patients and negatively for mildly impaired patients.

Clinical Relevance: The study provides evidence for the care of stroke patients at the IRF setting.

1Kaiser Foundation Rehabilitation Center, Kaiser Permanente Medical Center, Vallejo, CA, USA

2Health Department, State University of New York at Cortland, Cortland, NY, USA

3Uniform Data System for Medical Rehabilitation, Amherst, NY, USA

Published online 22 May 2015.

Correspondence

Michelle Camicia, Director, Kaiser Foundation Rehabilitation Center, 975 Sereno Dr. Vallejo, CA 94589. E-mail: michelle.camicia@kp.org

© 2016 Association of Rehabilitation Nurses.
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