Discharge planning is a critical step in the inpatient rehabilitation journey for individuals recovering from a stroke. Accurate prediction of the most appropriate discharge destination is essential for ensuring a smooth transition and optimal patient outcomes. This study delves into the effectiveness of Self Care Assessment Tool Scoring, specifically utilizing Section GG of the Inpatient Rehabilitation Facility – Patient Assessment Inventory, as a predictor of discharge placement for stroke patients after inpatient rehabilitation.
This retrospective, observational cohort study was conducted within a 150-bed inpatient rehabilitation facility in a metropolitan health system. The research encompassed a consecutive sample of 1051 adults and older adults admitted for stroke rehabilitation between January 2020 and June 2021. Participants were carefully selected, excluding those discharged to acute care or hospice, as well as individuals with COVID-19, to maintain the focus on typical stroke rehabilitation outcomes. The study did not involve any interventions, instead focusing on analyzing existing data to identify predictive factors.
The core of the analysis centered on Section GG self-care and mobility scores, which are integral to reimbursement formulations by the Centers for Medicare and Medicaid Services. These scores, collected at admission to inpatient rehabilitation, were analyzed alongside patient demographics such as age, sex, prior living situation, and the ultimate discharge setting. Logistic regression was employed to compare binary discharge destination outcomes. Receiver operating characteristic (ROC) curves were then utilized to pinpoint admission Section GG score cut-offs relevant to these binary comparisons, providing a quantifiable measure for prediction.
The results of the logistic regression unequivocally highlighted the presence of a caregiver in the home as the most robust predictor of discharge destination (P<.001). Significantly, admission Section GG scores emerged as crucial secondary factors in determining where patients were discharged. Specifically, the study identified a Section GG cut-off score of 33.5 for differentiating between discharge to home with homecare versus a skilled nursing facility (SNF). Furthermore, a cut-off score of 36.5 was established for distinguishing between discharge to home with outpatient care and discharge to a skilled nursing facility.
In conclusion, for clinicians making discharge decisions for stroke patients post-inpatient rehabilitation, considering the availability of a caregiver at home should be the initial step. Following this, the study suggests incorporating Section GG cut-off scores as valuable guidance in decisions regarding discharge to home (with or without homecare) versus SNF destinations. However, it is important to note that relying solely on Section GG cut-offs for the decision between home with outpatient services versus home with homecare is not recommended. The less robust area under the ROC curve for this comparison indicates that clinical judgment remains paramount in determining the optimal discharge plan in these scenarios. Interestingly, sex and race/ethnicity were not found to be significant determinants in binary discharge destination choices within this study.
