Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation

Abstract

ObjectiveTo identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DesignAn exploratory, observational design was used to analyze retrospective data from electronic medical records. SettingData were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. ParticipantsMedical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. InterventionsNot applicable. Main Outcome MeasuresThe primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. ResultsOne in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). ConclusionsThese findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients’ performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.