Characteristics of Acute Stroke Patients Readmitted to Inpatient Rehabilitation Facilities - a Cohort Study.

INTRODUCTION Reducing acute care readmissions from inpatient rehabilitation facilities (IRFs) is a healthcare reform goal. Stroke patients have higher acute readmission rates & persistent impairments, warranting second IRF hospitalization consideration. MAIN OUTCOME MEASURE Variables that increase the likelihood of a second IRF hospitalization. DESIGN Retrospective cohort study. SETTING Seven-center rehabilitation network. PARTICIPANTS Stroke patients, readmitted to acute care, who returned or did not return to an in-network IRF between 10/1/2014-12/31/2017(n=380). INTERVENTIONS Univariable analyses (Returned/Did Not Return to IRF) described demographics, stroke type & risk factors. Between group differences in readmission causes, motor impairments & functional independence measure(FIM) scores were examined. Return to IRF logistic regression model included variables with P<0.1. Odds Ratio & 95% CI were calculated; Relative Risk was calculated for categorical variables. P<0.05 equaled statistical significance. RESULTS 192 stroke patients returned to IRF, 188 did not. Returned to IRF patients were younger (60.6 vs 66 years; P<0.001), sustained hemorrhagic strokes (22.4 vs 14.2%; P=0.01), had lower cardiac disease prevalence (41.7 vs 55.3%; P=0.008) or non-Medicare insurance (59.9 vs 39.4%; P<0.001). Did Not Return to IRF patients had lower admission and discharge motor & total FIM scores. Per point decrease in discharge FIM, second IRF hospitalization odds increased 4% (OR 1.04; 95% CI 1.01-1.07; P=0.02). Hemorrhagic stroke patients had 33% increased odds or a 15% higher relative risk of second IRF hospitalization than ischemic stroke [OR 1.33; 95% CI 1.21-1.47; RR 1.15; 95% CI 1.1-1.2; P<0.001]. Non-Medicare insurance had 39% increased odds or a 20 percent higher relative risk of second IRF hospitalization than Medicare [OR 1.39; 95% CI 1.01-1.92; RR 1.2, 95% CI 1.006-1.404; P=0.04). CONCLUSIONS Hemorrhagic stroke, non-Medicare insurance or lower discharge FIM score during the first IRF hospitalization predict a second IRF stay. Further work is needed to establish the validity of within IRF stay readmission measures. This article is protected by copyright. All rights reserved.