HEALTH Study: Rehab stays shorter, but patient functions same

The focus of the study was on five major impairments.
SCRIPPS HOWARD
With reduced insurance payments, patients are staying in rehabilitation hospitals for shorter times but leaving with about the same level of functional recovery, a new study shows.
However, the death rate in the months following discharge from the hospitals has increased by about 4 percent.
The study, led by Kenneth Ottenbacher, a registered occupational therapist at the University of Texas Medical Branch in Galveston, was published Wednesday in The Journal of the American Medical Association.
The researchers looked at the records of more than 148,000 patients admitted to 744 medical rehabilitation hospitals in 48 states between 1994 and 2001.
They focused on five major impairments -- stroke, brain dysfunction from injuries, other neurologic conditions like Parkinson's disease, spinal cord dysfunction and orthopedic conditions such as hip fractures or joint replacement surgery.
The average age of the patients was 67.8 years (children under age 16 were not included), and the patients were 59 percent female and 81 percent non-Hispanic white.
They found that the average length of stay in the hospitals declined from 20 days to 12 days during the study period, with the greatest decline (42 percent) coming for patients with orthopedic problems.
What was expected
Much of the reduction has been driven by reduced insurance payments for rehab stays, a trend that is expected to continue under a new payment system implemented under Medicare in 2002.
The researchers cut their study off before that change took effect to try to set a baseline of what was happening in rehab care.
Ottenbacher said he had expected that shorter lengths of stay would result in reduced functional status for the patients and decreased ability to return to the community, but "no clinically significant change in daily living skills such as dressing and bathing was seen."
Rates of discharge to the home and being able to live at home when checked during a follow-up 80 to 180 days later remained stable at between 82 percent and 93 percent for the patients during the study period, with orthopedic patients having the highest rates, stroke patients the lowest.
However, mortality rates in the six months after the patients were discharged from the rehab hospitals rose from about 1 percent in 1994 to 4.7 percent in 2001 and were higher for all impairments except orthopedic patients.
The records showed patients coming into the system in 2001 had about the same functional scores and other medical problems as the 1994 population.
Rehab
The researchers said they couldn't determine why rehabilitation care became more efficient during the 1990s, although they note that patients are also being discharged more quickly from acute-care hospitals and thus starting rehab earlier.
Dr. Peter Esselman, a professor of rehabilitation medicine at the University of Washington and the Haborview Medical Center in Seattle, suggests in an accompanying editorial that the trend may also be partly responsible for the increased mortality rates after discharge.
"The medical stability of the patients admitted over this time may have changed due to the pressure to decrease acute-care length of stay," he said.
Philip Blot, director of rehabilitation at the Glen Cove, N.Y., Center for Nursing and Rehabilitation, who was not involved in the study, said, "with sophisticated rehabilitation equipment and a hands-on approach to healing, we are able to get patients moving more quickly than ever before."
But he argues that with hospital stays decreasing in length, it's more important for patients to follow a rehab routine recommended by their doctors and therapists at home.
"The biggest reason we see for permanent joint impairment and even death is the decrease or even cessation of rehabilitation that often occurs once a patient leaves a rehab facility," Blot said.