Functional Status Predicts Acute Care Readmissions from Inpatient Rehabilitation in the Stroke Population

被引：40

作者：

Slocum, Chloe ^{[1
,2
]}

Gerrard, Paul ^{[1
,2
]}

Black-Schaffer, Randie ^{[1
,2
]}

Goldstein, Richard ^{[1
]}

Singhal, Aneesh ^{[3
]}

DiVita, Margaret A. ^{[4
]}

Ryan, Colleen M. ^{[6
,7
]}

Mix, Jacqueline ^{[4
]}

Purohit, Maulik ^{[8
]}

Niewczyk, Paulette ^{[4
,5
]}

Kazis, Lewis ^{[9
]}

Zafonte, Ross ^{[1
,2
]}

Schneider, Jeffrey C. ^{[1
,2
]}

机构：

[1] Harvard Univ, Sch Med, Spaulding Rehabil Hosp, Dept Phys Med & Rehabil, Boston, MA 02138 USA

[2] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Phys Med & Rehabil, Boston, MA USA

[3] Harvard Univ, Sch Med, Dept Neurol, Massachusetts Gen Hosp, Boston, MA 02115 USA

[4] Uniform Data Syst Med Rehabil, Amherst, NY USA

[5] Daemen Coll, Hlth Care Studies Dept, Amherst, NY USA

[6] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Sumner Redstone Burn Ctr,Surg Serv, Boston, MA USA

[7] Shriners Hosp Children Boston, Boston, MA USA

[8] Ft Belvoir Community Hosp, Natl Intrepid Ctr Excellence, Intrepid Spirit 1, Neurorehabil & Traumat Brain Injury, Ft Belvoir, VA USA

[9] Boston Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA

来源：

PLOS ONE | 2015年 / 10卷 / 11期

关键词：

HOSPITAL READMISSIONS; PERFORMANCE; COMPLICATIONS; VALIDATION; DISCHARGE; HEALTH;

D O I：

10.1371/journal.pone.0142180

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Objective Acute care readmission risk is an increasingly recognized problem that has garnered significant attention, yet the reasons for acute care readmission in the inpatient rehabilitation population are complex and likely multifactorial. Information on both medical comorbidities and functional status is routinely collected for stroke patients participating in inpatient rehabilitation. We sought to determine whether functional status is a more robust predictor of acute care readmissions in the inpatient rehabilitation stroke population compared with medical comorbidities using a large, administrative data set. Methods A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed examining stroke patients admitted to inpatient rehabilitation facilities. A Basic Model for predicting acute care readmission risk based on age and functional status was compared with models incorporating functional status and medical comorbidities (Basic-Plus) or models including age and medical comorbidities alone (Age-Comorbidity). C-statistics were compared to evaluate model performance. Findings There were a total of 803,124 patients: 88,187 (11%) patients were transferred back to an acute hospital: 22,247 (2.8%) within 3 days, 43,481 (5.4%) within 7 days, and 85,431 (10.6%) within 30 days. The C-statistics for the Basic Model were 0.701, 0.672, and 0.682 at days 3, 7, and 30 respectively. As compared to the Basic Model, the best-performing Basic-Plus model was the Basic+Elixhauser model with C-statistics differences of +0.011, +0.011, and +0.012, and the best-performing Age-Comorbidity model was the Age+Elixhauser model with C-statistic differences of -0.124, -0.098, and -0.098 at days 3, 7, and 30 respectively. Conclusions Readmission models for the inpatient rehabilitation stroke population based on functional status and age showed better predictive ability than models based on medical comorbidities.

引用

页数：10

共 35 条

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