Using a Classification Process to Optimize Outcome of Stroke Rehabilitation

Abstract

ABSTRACTBackground: Although it is generally presumed that experienced clinicians are capable of making reasonable decisions concerning rehabilitation potential, inexperienced clinicians may expend efforts and resources somewhat unproductively in managing patients with nonprogressive neurological conditions such as stroke. Clinicians with varied experience may also be influenced by extraneous factors least likely to contribute to an effective admission and treatment planning. Purpose: We report a process for efficient utilization of resources to maximize outcome following stroke rehabilitation. Description: A care planning process with distinctive features of patient profiling, treatment tracking, and outcome staircasing was developed and utilized in the subacute stroke management of African American stroke survivors in an inpatient facility in New York. Outcome of stroke rehabilitation care were compared before and after the implementation of the process using Functional Independence Measures (FIM) scores in activities of daily living, Length of Stay (LOS), FIM change at discharge, and LOS efficiency. A priori comparison of outcome before and after program implementation was also made with those of similar facilities in the region and in the nation. Results: The results show significant decrease in LOS and consistent improvement in LOS efficiency following program implementation. While averages in LOS and LOS efficiency approach those of similar facilities in the region and nation, a trend of FIM change that exceeded regional and national averages observed before program continued postprogram implementation. Conclusion: A structured process involving patient profiling and treatment tracking could result in improved outcome in stroke rehabilitation.