ORIGINAL RESEARCH
Measuring Discharge Outcomes, Length of Stay, and Functional ADL Score During COVID-19 in Inpatient Rehabilitation Hospitals

https://doi.org/10.1016/j.apmr.2021.07.003Get rights and content

Abstract

Objective

To measure discharge disposition, length of stay (LOS), and functional activities of daily living (ADL) scores for patients admitted to acute inpatient rehabilitation hospitals (IRHs) during the coronavirus disease 2019 (COVID-19) pandemic and to compare these parameters with a period prior to the pandemic.

Design

Retrospective cohort study via systematic retrospective chart review of consecutive patients admitted to IRHs from January 1-February 19, 2020 (pre–COVID-19T), and COVID-19 time period/patients admitted from April 1, 2020-May 9, 2020 (COVID-19T).

Setting

System of 3 IRHs in the Northeastern United States.

Participants

Pre–COVID-19T, n=739; COVID-19T, n=335, of whom n=139 were positive for COVID-19 (COVID+) and n=196 were negative (COVID−) (N=1074).

Interventions

Not applicable.

Main Outcome Measures

Discharge disposition, LOS, and functional ADL scores.

Results

COVID-19T patients were younger (P=.03) and less likely to be White (P=.03). These patients also had a higher case mix index (CMI; P<.01), longer acute care LOS (P<.01), and longer IRH LOS (P<.01). Patients who were COVID+ (during COVID-19T) were less likely to be White (P<.01), had lower CMI (P<.01), had higher admission and discharge functional ADL scores (P=.02, P<.01), and had longer acute care LOS compared with those who were COVID− (P<.01). There were no differences in discharge outcomes between pre–COVID-19T and COVID-19T cohorts (P=.75), including when stratified for COVID-19 status (P=.74). Functional ADL scores on admission and discharge were lower in COVID-19T than in pre–COVID-19T (P=.01), including when stratified for COVID-19 status though not significant (P=.06).

Conclusions

There were no differences in discharge outcomes for any group. IRH LOS was significantly increased during the pandemic, but there were no statistically significant differences between the COVID+ and COVID− cohorts within COVID-19T. Functional ADL scores were significantly lower during COVID-19T, but COVID status was not a significant predictor. This suggests that COVID+ status was not a barrier to discharge or functional outcomes. This supports the importance of IRHs to restore function and discharge patients to home, even with a more medically complex COVID-19 pandemic population.

Keywords

Activities of daily living
COVID-19
Functional status
Length of stay
Patient discharge
Physical and rehabilitation medicine
Rehabilitation
SARS-CoV-2

List of abbreviations

ACH
acute care hospital
ADL
activities of daily living
BMI
body mass index
CMI
case mix index
COVID-19
coronavirus disease 2019
COVID-19T
COVID-19 time period/patients admitted from April 1, 2020-May 9, 2020
GG
Functional Abilities and Goals subscale scores
IRH
inpatient rehabilitation facility
LOS
length of stay
LTACH
long-term acute care hospital
OR
odds ratio
pre-COVID-19T
pre-COVID-19 time period/patients admitted from January 1, 2020-February 19, 2020
SNF
skilled nursing facility

Cited by (0)

Presented as poster to the Association of Academic Physiatrists, February 12 2021, virtual.

Disclosures: None.

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