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Selection for rehabilitation: Acute care discharge patterns for stroke and orthopaedic patients

journal contribution
posted on 28.05.2019, 00:00 by Carolyn Unsworth
This study aimed to develop predictive models to assist clinicians working in acute care to determine which stroke and lower limb orthopaedic patients should be discharged to nursing homes, inpatient rehabilitation, or home. The subjects were 223 patients with stroke and 125 patients with lower limb orthopaedic problems, aged 60 years and over, and the 22 acute care and rehabilitation clinicians who cared for these patients. Patient status was measured within 72 hours of discharge using the Adult FIMSM ŽGuide for the Uniform Data Set for Medical Rehabilitation, 1993. and ten additional items from either the RICFAS ŽRehabilitation Institute of Chicago, 1987. or developed for this research. Four mathematical models were developed to predict discharge destination using stepwise discriminant function analysis. Using between three and seven items from the FIMSM alone or FIMSM plus additional variables, these models correctly classified between 74.9% and 80.5% of patients. In conclusion, clinicians are offered a selection of models to guide their discharge destination decisions for two large groups of patients. While these models cannot replace clinical judgement, they increase the transparency of decisions. The use of objective models to guide clinical decisions are essential, particularly given increasing pressure to justify patient access to costly rehabilitation services.

Funding

Category 2 - Other Public Sector Grants Category

History

Volume

24

Issue

2

Start Page

103

End Page

114

Number of Pages

12

ISSN

0342-5282

Publisher

Lippincott Williams & Wilkins, Ltd.

Language

en

Peer Reviewed

Yes

Open Access

No

External Author Affiliations

La Trobe University

Journal

International Journal of Rehabilitation Research