Clinical and psychosocial predictors of exceeding target length of stay during inpatient stroke rehabilitation^*

* This study was completed in partial fulfillment of an MScPT degree at the University of Toronto. Nancy M. Salbach holds Ontario Ministry of Research and Innovation Early Researcher and Canadian Institutes of Health Research New Investigator Awards

Abstract

Background: In Ontario, Canada, patients admitted to inpatient rehabilitation hospitals post-stroke are classified into rehabilitation patient groups based on age and functional level. Clinical practice guidelines, called quality-based procedures, recommend a target length of stay (LOS) for each group.

Objectives: The study objective was to evaluate the extent to which patients post-stroke at an inpatient rehabilitation hospital are meeting LOS targets and to identify patient characteristics that predict exceeding target LOS.

Methods: A quantitative, longitudinal study from an inpatient rehabilitation hospital was conducted. Participants included adult patients (≥18 years) with stroke, admitted to an inpatient rehabilitation hospital between 2014 and 2015. The percentage of patients exceeding the recommended target LOS was determined. Logistic regression was performed to identify clinical and psychosocial patient characteristics associated with exceeding target LOS after adjusting for stroke severity.

Results: Of 165 patients, 38.8% exceeded their target LOS. Presence of ataxia, recurrent stroke, living alone, absence of a caregiver at admission, and acquiring a caregiver during hospital LOS was each associated with significantly higher odds of exceeding target LOS in comparison to patients without these characteristics after adjusting for stroke severity (p < 0.05).

Conclusions: Findings suggest that social and stroke-specific factors may be helpful to adjust LOS expectations and promote efficient resource allocation. This exploratory study was limited to findings from one inpatient rehabilitation hospital. Cross-validation of results using data-sets from multiple rehabilitation hospitals across Ontario is recommended.

Keywords:

• Stroke
• inpatient rehabilitation
• target length of stay
• health services
• quality-based procedures
• clinical factors
• psychosocial predictors

Notes

* This study was completed in partial fulfillment of an MScPT degree at the University of Toronto. Nancy M. Salbach holds Ontario Ministry of Research and Innovation Early Researcher and Canadian Institutes of Health Research New Investigator Awards