Role of Inpatient Rehabilitation Facility Quality Measures to Predict Community Discharge After Stroke

Research Objectives: Main objective: Examine the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and inpatient rehabilitation facility (IRF) admission functional status, measured by the IRF-Patient Assessment Instrument (IRF-PAI) self-care and mobility quality measures, to deduce if quality measures can serve as a proxy for stroke severity. The self-care and mobility quality measures are indicators of physical function.
Secondary objective: Investigate the predictive power of the NIHSS and IRF-PAI admission physical function quality measures to predict community discharge from IRF after stroke.

Design: Retrospective cohort study using electronic health records and Uniform Data System Medical Record file data from January 1, 2018 to December 30, 2019.

Setting: Academic hospital-based IRF.

Participants: 544 patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria: transient ischemic attack, discharged against medical advice, died during IRF stay, or re-admitted to acute care within 48 hours of IRF admission. Cases with incomplete data (missing IRF-PAI, NIHSS scores) were excluded from analyses.

Interventions: Not applicable.

Main Outcome Measures: Community discharge status from IRF.

Results: Of 544 patients, 76.6% had community discharge; the median age was 64.7 years. NIHSS scores were available for 434 patients, with the majority of patients classified as minor to moderate stroke (n=294). NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category (n=433). There was no association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each a significant predictor of successful discharge to the community (n=430; OR=1.09, 95% CI: 1.03 – 1.17, OR=1.1, CI: 1.03 – 1.18, respectively). NIHSS scores from acute care were not a significant predictor of community discharge (OR = 0.70 CI 0.47-1.04) from IRF.

Conclusions: IRF-PAI self-care quality measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge status.

Author(s) Disclosures: No disclosures or conflicts of interest.