In the past decade, the average length of stay (LOS) among patients undergoing inpatient rehabilitation has declined significantly, from a median of 20 days in 1994 to 12 days in 2001. The primary question, of course, is whether the quality of care has diminished along with the LOS. Now researchers have determined that the answer is no. Maybe.
Researchers tapped the Uniform Data System for Medical Rehabilitation, a large national database considered "representative of rehabilitation patients in the United States." They reviewed nearly 149,000 inpatient records (including those of patients with stroke, brain or spinal cord dysfunction, other neurologic conditions, or orthopedic conditions) from 1994 to 2001, to determine basic daily living-skill scores (as determined using the Functional Independence Measure, or FIM) on admission, at discharge, and during follow-up.
Surprisingly, the scores on the FIM changed very little over the eight years in which LOS declined. Although patients' time in rehabilitation decreased, the treatment they were receiving there was no less effective; the relatively unchanged scores imply also that the treatment received was more efficient (more was being accomplished in less time). The numbers of patients discharged home or living at home after treatment didn't change substantially during the study period.
Again surprising the authors-in light of the lack of changes in functional-status scores-the mortality rates from discharge to follow-up in all five categories rose, from less than 1% in 1994 to 4.7% in 2001. The increases don't appear to be related to age or to a trend toward admitting patients to rehabilitation who're sicker and have more comorbid conditions. The authors suggest that patients with less severe disabilities are being sent home (and receiving home health care) or to subacute rehabilitation units such as nursing homes and that, consequently, those with more severe problems are being admitted to the medical rehabilitation units.-Doug Brandt
Ottenbacher KJ, et al. JAMA 2004;292 (14):1687-95.