Stroke rehabilitation: Clinical predictors of resource utilization

Abstract

Objective: To identify predictors of rehabilitation hospital resource utilization for patients with stroke, using demographic, medical, and functional information available on admission. Design: Statistical analysis of data prospectively collected from stroke rehabilitation patients. Setting: Large, urban, academic freestanding rehabilitation facility. Participants: A total of 945 stroke patients consecutively admitted for acute inpatient rehabilitation. Main Outcome Measures: Resource utilization was measured by rehabilitation length of stay (LOS) and mean hospital charge per day (CPD). Methods: Independent variables were organized into categories derived from four consecutive phases of clinical assessment: (1) patient referral information, (2) acute hospital record review and patient history, (3) physical examination, and (4) functional assessment. Predictors for LOS and CPD were identified separately using four stepwise multiple linear regression analyses starting with variables from the first category and adding new category data for each subsequent analysis. Results: Severe neurologic impairment, as measured by Rasch-convened NIH stroke scale and lower Rasch- converted motor measure of the Functional Independence Measure (FIM) instrument predicted longer LOS (F2,824 = 231.9, p < .001). Lower Rasch- converted motor FIM instrument measure, tracheostomy, feeding tube, and a history of pneumonia, coronary artery disease, or renal failure predicted higher CPD (F6,820 = 90.2, p < .001). Conclusion: Stroke rehabilitation LOS and CPD are predicted by different factors. Severe impairment and motor disability are the main predictors of longer LOS; motor disability and medical comorbidities predict higher CPD. These findings will help clinicians anticipate resource needs of stroke rehabilitation patients using medical history, physical examination, and functional assessment.