1 of 1

Aim 1 - Results of the multinomial logistic regression model:

• NIHSS scores were significantly associated with IRF-PAI admission self-care scores
• For a moderate stroke, one unit increase in admission self care total was associated with a 0.08 (P=0.004) decrease in NIHSS score
• No association was found between NIHSS and IRF-PAI admission mobility scores

Role of Inpatient Rehabilitation Facility Functional Measures to Predict Community Discharge After Stroke

Table 3. Variables Predictive of Community Discharge from an IRF after stroke

1. University of Arizona College of Medicine - Phoenix, Phoenix, AZ 2. Department of Physical Therapy and Athletic Training, Northern Arizona University, Phoenix, AZ

Background: Stroke is a leading cause of morbidity and mortality in the United States¹

• About two-thirds of stroke survivors require post-acute rehabilitation services after hospital discharge¹
• The Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) has included new standardized measures of physical function assessed at admission and discharge to IRFs²
• The National Institutes of Health Stroke Scale (NIHSS) is a measure of stroke severity and is predictive of patient discharge disposition from an acute care stay³

Objectives:

• Examine the association between NIHSS scores measured during the acute care stay and IRF admission functional status, measured by the IRF-PAI self-care and mobility function measures, to deduce if IRF-PAI measures can serve as a proxy for stroke severity
• Investigate the predictive power of the NIHSS and IRF-PAI admission physical function quality measures to predict community discharge from IRF after stroke

Introduction

Results

Conclusions

In this study, we analyzed the association between NIHSS scores and IRF-PAI admission function measures. We also demonstrated the predictive power of functional variables to predict discharge from an IRF after stroke.

• Based on the association, IRF-PAI admission self-care can serve as a proxy for stroke severity in the IRF setting.
• Future prospective studies should be focused on further quantifying predictive abilities of IRF-PAI admission quality measures and change in IRF-PAI measures during an IRF stay for use in risk adjustment modeling.

References

• Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation. 2019;139(10):e56-e528
• Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. :L 113-185, 128 Stat 1952.
• Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation. Claims-Based and Hybrid Measures of 30-Day Mortality Following Acute Ischemic Stroke Hospitalization Incorporating Risk Adjustment for Stroke Severity. 2015.

Elizabeth Mangone¹, Eashan Shahriary, PhD¹, Pamela Bosch PT, DPT, PhD^1,2

Results (continued)

• The study sample included 544 patients with stroke who received care at the hospital-based IRF after discharge from an acute care hospital stay
• 67.7% had a minor to moderate stroke; 76.7% had community discharge

Aim 2 - Results of the multiple logistic regression model:

• IRF admission self-care (OR 1.09, 95% CI: 1.03 – 1.17) and mobility scores (OR 1.10, 95% CI: 1.03 – 1.18) each increased the likelihood of discharge to the community
• NIHSS scores from acute care were not a significant predictor of community discharge (OR 0.70, 95% CI: 0.47-1.04) from IRF
• Caregiver availability (P<0.0001) significantly increased the likelihood of community discharge

Methods

Methods: 

• Patients with ischemic or hemorrhagic stroke transferred from an acute care hospital to IRF
• Secondary analysis of data extracted from electronic health records linked with the Uniform Data System for Medical Rehabilitation
• IRF care between January 1, 2018, and December 30, 2019

Setting:

• One academic hospital-based IRF

Outcome: 

• Admission IRF-PAI self-care and mobility data
• Community discharge status from IRF
• Defined by the Centers for Medicare and Medicaid Services IRF Quality Measure: “patients being discharged to home (routine discharge) or transferred to home with organized home health services”

Table 2. Association between NIHSS scores and IRF-PAI Measures

Table 1. Post-stroke patient characteristics during IRF stay

*Minor to moderate stroke used as baseline comparison