Wednesday, October 13, 2004

Rehabilitation Trends: Decreased Length of Stay and Mortality

Usually, the weekly online issue of the Journal of the American Medical Association includes the full text of one of its articles available on a free-access basis. Today's new issue has as its "free access" choice a report on trends in rehabilitation care: [access the article here]. A .pdf version is also available at the access page.

Here is the paper's abstract:
Kenneth J. Ottenbacher, PhD, OTR; Pam M. Smith, DNS, RN; Sandra B. Illig, MS, RN; Richard T. Linn, PhD; Glenn V. Ostir, PhD; Carl V. Granger, MD. Trends in Length of Stay, Living Setting, Functional Outcome, and Mortality Following Medical Rehabilitation. JAMA. 2004; 292: 1687-1695.

Context.  Changes in reimbursement have reduced length of stay (LOS) for patients receiving inpatient medical rehabilitation. The impact of decreased LOS on functional status, living setting, and mortality is not known.

Objective.  To examine changes in LOS, functional status, living setting, and mortality in patients completing inpatient rehabilitation.

Design.  Retrospective cohort study from 1994 through 2001 using information submitted to the Uniform Data System for Medical Rehabilitation.

Setting and Participants.  Data were analyzed from 744 inpatient medical rehabilitation hospitals and centers located in 48 US states. A total of 148 807 patient records from 5 impairment groups (stroke, brain dysfunction, spinal cord dysfunction, other neurologic conditions, and orthopedic conditions) were examined. Patients’ mean age was 67.8 (SD, 15.8) years; the sample was 59% female and 81% non-Hispanic white.

Main Outcome Measures.  Discharge setting, follow-up living setting, change in functional status, and mortality.

Results.  Median LOS decreased from 20 to 12 days (P less than .001) from 1994 to 2001. The proportional decrease in median LOS was greatest (42%) for patients with orthopedic conditions. Mean days to follow-up remained constant from 89 in 1994 to 90 in 2001. Functional status was clinically stable, while efficiency (functional status change divided by LOS) increased significantly (P less than .001). Rates of discharge to home and living at home at follow-up remained stable, ranging from 81% to 93%. However, mortality at 80- to 180-day follow-up increased from less than 1% in 1994 to 4.7% in 2001.

Conclusions.  Length of stay for inpatient rehabilitation decreased substantially from 1994 to 2001. Effectiveness as measured by change in functional status did not change clinically, and living setting did not change. Efficiency for functional outcomes improved but mortality at follow-up increased.

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