Discharge disposition from model spinal cord injury care system rehabilitation programs

Objective: To identify and quantify factors associated with discharge to a nursing home for people with spinal cord Injuries. Design: Case control within a cohort of spinal cord injured persons. Setting: Model spinal cord injury care systems throughout the United States . Patients: A total 16,633 patients consecutively discharged alive between 19 73 and 1996 who were admitted to the model system within 1 year of injury, who were both injured in and resided in the catchment area of the model sys tem, and who were discharged to either a nursing home or a community reside nce. Main Outcome Measure: Discharge disposition. Results: Overall, 4.3% of patients were discharged to a nursing home. Facto rs that were significantly associated (p < .0001) with place of discharge w ere age, race, employment status at injury, bladder management method at di scharge, education level, marital status, Frankel grade, functional indepen dence in performing activities of daily living, independent ambulation, geo graphic region, neurologic level of injury, ventilator dependency, and thir d-party sponsor of rehabilitation. A multivariate predictive model was deve loped from these factors and was both 78% sensitive and specific in identif ying patients who were discharged to a nursing home. Conclusions: Knowing the probability of nursing home placement can assist i n evaluating the success of a rehabilitation program by allowing adjustment for case-mix differences across facilities. (C) 1999 by the American Congr ess of Rehabilitation Medicine and the American Academy of Physical Medicin e and Rehabilitation.