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Titre : | Association Between Delayed Discharge From Acute Care and Rehabilitation Outcomes and Length of Stay: A Retrospective Cohort Study (2023) |
Auteurs : | Berk Görgülü ; Jing Dong ; Karen Hunter ; Krista M. Bettio ; Betty Vukusic ; Jonathan Ranisau ; Gary Spencer ; Terence Tang ; Vahid Sarhangian |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 104, n° 1, 2023) |
Article en page(s) : | p. 43-51 |
Note générale : | https://doi.org/10.1016/j.apmr.2022.05.017 |
Langues: | Français |
Descripteurs : |
HE Vinci Admission du patient ; Durée du séjour ; Réadaptation ; Soins de suite |
Résumé : | Objective To examine the association between discharge delays from acute to rehabilitation care because of capacity strain in the rehabilitation units, patient length of stay (LOS), and functional outcomes in rehabilitation. Design Retrospective cohort study using an instrumental variable to remove potential biases because of unobserved patient characteristics. Setting Two campuses of a hospital network providing inpatient acute and rehabilitation care. Participants Patients admitted to and discharged from acute care categories of Medicine and Neurology/Musculoskeletal (Neuro/MSK) and subsequently admitted to and discharged from inpatient rehabilitation between 2013 and 2019 (N=10486). Interventions None. Main Outcome Measures Rehabilitation LOS, FIM scores at admission and discharge, and rehabilitation efficiency defined as FIM score improvement per day of rehabilitation. Results The final cohort contained 3690 records for Medicine and 1733 for Neuro/MSK categories. For Medicine, 1 additional day of delayed discharge was associated with an average 5.1% (95% confidence interval [CI], 3%-7.3%) increase in rehabilitation LOS and 0.08 (95% CI, 0.03-0.13) reduction in rehabilitation efficiency. For Neuro/MSK, 1 additional day of delayed discharge was associated with an average 11.6% (95% CI, 2.8%-20.4%) increase in rehabilitation LOS and 0.08 (95% CI, ?0.07 to 0.23) reduction in rehabilitation efficiency. Conclusions Delayed discharge from acute care to rehabilitation because of capacity strain in rehabilitation had a strong association with prolonged LOS in rehabilitation. An important policy implication of this ?cascading? effect of delays is that reducing capacity strain in rehabilitation could be highly effective in reducing discharge delays from acute care and improving rehabilitation efficiency. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999322004750 |