Abstract 58: Adherence To Discharge Rehabilitation Recommendations May Decrease Unplanned Care And Improve Patient Outcomes

Abstract

Adherence to Discharge Rehabilitation Recommendations May Decrease Unplanned Care and Improve Patient Outcomes Introduction Unplanned episodes of care result in increased cost to patients and institutions. Minimal data exist correlating discharge recommendation by rehabilitation specialists to patient outcomes. We aimed to evaluate the discharge recommendation of rehabilitation team (physiatry, occupational and physical therapies) versus actual discharge location and their relationship of unplanned episodes of care and ninety day outcomes. Method: A single center retrospective analysis of Acute Ischemic Stroke (AIS) patients discharged from January to September 2020. We excluded those that were discharged to hospice and expired during the initial encounter. Our primary outcome was to examine unplanned care episodes in comparison to the adherence of the rehabilitation team’s discharge recommendation. The secondary outcome examined the 90 day modified Rankin Score in comparison to the discharge recommendations. Stepwise logistic regression and ordinal regression models were utilized to analyze primary and secondary outcomes. Results: A total of 544 patients were evaluated. After exclusions we included 385 patients; 301 (78.2%) followed the discharge recommendation. Agreement on discharge location between physiatry and therapy modalities was 85.7%. When physiatrist final recommendations were unavailable, agreement between occupational and physical therapy decreased to 83.9%. Patients who adhered to rehabilitation recommendations were less likely to experience unplanned care compared to patients who did not (23.7% vs. 28.6%), although the difference was not statistically significant; adjusted odds ratio (aOR) = 0.63 [95%CI, 0.36 - 1.10], p = 0.10. Similarly, patients adhering to recommendations experienced less disability at 90 days compared to those who did not, although the difference was not statistically significant; aOR = 0.64 [95%CI, 0.39 - 1.06], p = 0.08. Conclusion: When the patients followed the recommendations of the rehabilitation team, a trend was found towards a decrease in unplanned care and better outcomes. Findings suggest additional research is warranted.