Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities

doi:10.1016/j.apmr.2016.06.005

Archives of Physical Medicine and Rehabilitation

Volume 97, Issue 12, December 2016, Pages 2068-2075

Presented in part as a poster to the American Congress of Rehabilitation Medicine, October 28, 2015, Dallas, TX.

https://doi.org/10.1016/j.apmr.2016.06.005 Get rights and content

Abstract

Objectives

To describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation, and examine the independent effects of social support on deviations from expected lengths of stay.

Design

Retrospective cohort study.

Setting

Inpatient rehabilitation facilities.

Participants

Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 after stroke, lower extremity fracture, or lower extremity joint replacement.

Intervention

Not applicable.

Main Outcome Measure

Relative length of stay (actual minus expected). The Centers for Medicare & Medicaid Services posts annual expected lengths of stay based on patients' clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none.

Results

Mean ± SD actual lengths of stay for joint replacement, fracture, and stroke were 9.8±3.6, 13.8±4.5, and 15.8±7.3 days, respectively; relative lengths of stay were −1.2±3.1, −1.6±3.7, and −1.7±5.2 days. Nearly half of patients (47%–48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (P<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement.

Conclusions

Inpatient rehabilitation experiences and outcomes can be substantially affected by a patient's level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures.

Section snippets

Data source

Medicare data were obtained from the CMS. We selected patients discharged from IRFs in 2012 using the 100% Inpatient Rehabilitation Facility–Patient Assessment Instrument file. We then linked the assessment data from those cases to the claims data in the Medicare Provider Analysis and Review file and the enrollment and demographic data in the Beneficiary Summary File.10, 11 A data usage agreement was established with the CMS, and the study was approved by the university's institutional review

Results

Table 1 provides sample characteristics for the 3 impairment groups. Mean ages ± SD ranged from 73.2±9.2 years for joint replacement to 79.7±9.4 years for fracture. The percentages of patients reporting they have family or friends, or both, for social support for fracture, joint replacement, and stroke were 62%, 65%, and 69%, respectively. Admission FIM motor ratings ranged from 35.8±10.0 for fracture to 42.7±9.2 for joint replacement. The percentages of patients with no tier comorbidities were

Discussion

Many studies2, 3, 4, 5 have reported on the trend in decreasing lengths of stay since implementation of the IRF prospective payment system and have examined the potential impacts of these shorter stays on clinical outcomes. However, there is no published information on the degree to which the Medicare inpatient rehabilitation population deviates from its condition-specific expected lengths of stay, or on patient characteristics that may be associated with either shorter- or longer-than-expected

Conclusions

Almost half of Medicare beneficiaries receiving inpatient rehabilitation services for stroke, lower extremity fracture, and joint replacement are discharged more than 1 day earlier than expected. Our findings provide new information on variables influencing length of stay to the growing body of evidence that inpatient rehabilitation experiences and outcomes can be substantially affected by a patient's level of social support. More research is needed to better understand the effects of social

Supplier

a.
SAS for Windows, version 9.3; SAS Institute, Inc.

Acknowledgments

We thank Jessica M. Jarvis, BS, and Ioannis Malagaris, MS, for their contributions in formulating and designing the project and their critical feedback during the development of this manuscript.

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: Supported in part by the National Institutes of Health (grant nos. P2CHD065702 and K01HD086290) and the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90IF0071).

: Disclosures: none.

View full text

Original researchSocial Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities

Abstract

Objectives

Design

Setting

Participants

Intervention

Main Outcome Measure

Results

Conclusions

Section snippets

Data source

Results

Discussion

Conclusions

Supplier

Acknowledgments

J Health Econ

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2014. Final rule

Fed Regist

The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes

Am J Phys Med Rehabil

The Uniform Data System for Medical Rehabilitation: report of patients with hip fracture discharged from comprehensive medical programs in 2000-2007

Am J Phys Med Rehabil

Trends in inpatient rehabilitation stroke outcomes before and after advent of the prospective payment system: a systematic review

J Neurol Phys Ther

Rehabilitation following total knee replacement, total hip replacement, and hip fracture: a case-controlled comparison

J Geriatr Phys Ther

Stroke rehabilitation: availability of a family member as caregiver and discharge destination

Eur J Phys Rehabil Med

Original research
Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities