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Comparative Study
. 2021 Dec;102(12):2291-2299.
doi: 10.1016/j.apmr.2021.07.003. Epub 2021 Jul 23.

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

Caitlin Hartsgrove  1 , Jenieve Guevarra-Fernandez  2 , Jamila Kendall  3 , Gabrielle Delauter  4 , Steven Kirshblum  3
Affiliations
Comparative Study

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

Caitlin Hartsgrove et al. Arch Phys Med Rehabil. 2021 Dec.

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.

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Figures

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Fig 1
Discharge disposition by time period and COVID-19 status.
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