New Study Results by Spaulding and Harvard Researchers Suggests Functional Status a Better Readmissions Indicator for Stroke Populations

(Boston, MA)- A new retrospective study published in PLOS ONE by researchers from Spaulding Rehabilitation Hospital and Harvard Medical School found that readmission models based on functional status consistently outperformed models based on medical comorbidities in the Stroke population.  Stroke is the leading cause of disability in the United States with young stroke rates rising people are living much longer today post stroke.  Acute Care Readmissions of stroke patients is one of the greatest challenges to the long-term health and quality of life for this population as well as adding billions of dollars of costs annually to the healthcare system. The research team examining the issue conducted a retrospective study of 803,124 stroke patients in the Uniform Data System for Medical Rehabilitation database who were admitted to inpatient rehabilitation facilities between 2002 and 2011.

“These study results continue to build the case that functional status should be a major factor used to determine the likelihood of readmissions. It is incumbent on the medical community to ensure that any possible setbacks such as readmissions that can be prevented be identified to ensure stroke survivors can reach their maximum potential for quality of life.,” said principal investigator Dr. Jeffrey Schneider, Medical Director, Burn and Trauma Rehabilitation Program at Spaulding Rehabilitation Hospital, Assistant Professor at Harvard Medical School.

For the study, logistic regression models based on function and gender were developed to predict the odds of three, seven, and thirty day readmission from inpatient rehabilitation facilities to acute care hospitals for stroke patients.  These function-based models were compared with models based instead on comorbidities and age.  Additionally, comorbidities were added to the function-based models to determine whether this improved model predictive ability.  Functional status was measured by a validated, standardized assessment—the Functional Independent Measure (FIMTM). Comorbidities were assessed using three different comorbidity measures (the Elixhauser index, Deyo-Charlson index and Medicare comorbidity tier system). 

Model performance was assessed using c-statistics, a statistical test used to assess the ability of the model to predict patients that require readmission to the acute care hospital. For 3-, 7-, and 30-day readmissions, models based on function and gender (c-statistics 0.701, 0.672, and 0.682, respectively) performed significantly better than even the best-performing models based on comorbidities and age (c-statistics 0.577, 0.574, 0.584, respectively).  Furthermore, the addition of comorbidities to function-based models did not appreciably improve model performance (c-statistic differences of only .011, 0.011, and 0.012 for 3-, 7-, and 30-day readmissions, respectively, for the best-performing models). 

“The growing body of data focused on readmission risk models shows a major opportunity to improve care for patients and more fairly reimburse hospitals based on performance. For the thousands of stroke survivors each year, we are hopeful new care models that focus on early function-based interventions can make a tangible difference by reducing readmission risk,” said Schneider.

About Spaulding Rehabilitation Network

A member of Partners HealthCare, The Spaulding Rehabilitation Network includes Spaulding Rehabilitation Hospital, which is a national model for environmental and inclusive design as well as Spaulding Rehabilitation Hospital Cape Cod, Spaulding Hospital Cambridge, two skilled nursing facilities, and twenty three outpatient sites throughout Eastern Massachusetts. Spaulding strives to continually update and improve its programs to offer patients the latest, high-quality care through its leading, expert providers. Spaulding has been awarded a Model Systems designation in three specialty areas- Brain Injury, Burn Injury Rehabilitation, and Spinal Cord Injury - by the National Institute on Disability and Rehabilitation Research. Spaulding is a teaching hospital of Harvard Medical School as well as the official rehabilitation hospital of the New England Revolution. Spaulding is the only rehabilitation hospital in New England continually ranked since 1995 by U.S. News and World Report in its Best Hospitals survey with a #6 ranking in 2015. For more information, please visit www.spauldingrehab.org.   

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