STROKE REHABILITATION - CLINICAL PREDICTORS OF RESOURCE UTILIZATION

Objective: To identify predictors of rehabilitation hospital resource utilization for patients with stroke, using demographic, medical, and functional information available on admission. Design: Statistical ana lysis of data prospectively collected from stroke rehabilitation patie nts. Setting: Large, urban, academic freestanding rehabilitation facil ity. Participants: A total of 945 stroke patients consecutively admitt ed for acute inpatient rehabilitation. Main Outcome Measures: Resource utilization was measured by rehabilitation length of stay (LOS) and m ean hospital charge per day (CPD). Methods: Independent variables were organized into categories derived from four consecutive phases of cli nical assessment: (1) patient referral information, (2) acute hospital record review and patient history, (3) physical examination, and (4) functional assessment. predictors for LOS and CPD were identified sepa rately using four stepwise multiple linear regression analyses startin g with variables from the first category and adding new category data for each subsequent analysis. Results: Severe neurologic impairment, a s measured by Rasch-converted NIH stroke scale and lower Rasch-convert ed motor measure of the Functional Independence Measure (FIM) instrume nt predicted longer LOS (F-2,F-824 = 231.9, p <.001). Lower Rasch-conv erted motor FIM instrument measure, tracheostomy, feeding tube, and a history of pneumonia, coronary artery disease, or renal failure predic ted higher CPD (F-6,F-820 = 90.2, p <.001). Conclusion: Stroke rehabil itation LOS and CPD are predicted by different factors. Seven impairme nt and motor disability are the main predictors of longer LOS; motor d isability and medical comorbidities predict higher CPD. These findings will help clinicians anticipate resource needs of stroke rehabilitati on patients using medical history, physical examination, and functiona l assessment. (C) 1998 by the American Congress of Rehabilitation Medi cine and the American Academy of Physical Medicine and Rehabilitation.