Prediction of Discharge Destination After Inpatient Rehabilitation for Stroke Using Mobility and Self-Care Assessment in Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Instrument

Abstract

ObjectiveTo determine the ability of Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Inventory (Section GG)’s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation. DesignRetrospective, observational cohort study. Setting150-bed inpatient rehabilitation facility within a metropolitan health system. ParticipantsConsecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19. InterventionNone. Main Outcome MeasuresSection GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons. ResultsLogistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (P<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility. ConclusionClinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.