RISK-FACTORS FOR DEATH AND EMERGENCY TRANSFER IN ACUTE AND SUBACUTE INPATIENT REHABILITATION

Objectives: To compare the risk of death or emergency transfer(ET) to an acute care hospital for acute and subacute rehabilitation inpatient s, to identify risk factors, and to determine whether the risk factors vary by level of care. Design: Proportional hazards regression analys is of retrospective cohort data. Explanatory variables included level of care, age, sex, medical stability at admission, and diagnosis. Sett ing: An acute inpatient rehabilitation hospital and a skilled nursing facility-based subacute rehabilitation program. Patients: Patients wer e selected from a database of all acute and subacute inpatients discha rged between January 1992 and August 1993 (N = 4,755). Readmissions an d pediatric patients were excluded (n = 896). Patients who had complet e data (n = 3,185) were included in the survival analysis; a separate univariable analysis was performed for patients who lacked complete da ta (n = 673). Outcome Measure: Rate of death or emergency transfer dur ing rehabilitation. Results: The overall risk was greater for subacute patients than for acute inpatients, 20.6% vs 11.6%, odds ratio = 2.0, CI = 1.6 to 2.5. The survival analysis indicated that age, level of c are, sex, and stability were associated with the risk of death or emer gency transfer (2.1 less than or equal to z less than or equal to 4.7; p <.05 for each). However, the difference in risk between subacute an d acute care was greatest among younger patients. Conclusions: Careful consideration of risk factors is critical for proper assignment of pa tients to rehabilitation levels of care. However, research is needed t o test these findings in other settings and to improve identification of high-risk patients. (C) 1996 by the American Congress of Rehabilita tion Medicine and the American Academy of Physical Medicine and Rehabi litation