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

Abstract

\n Objective\n To measure discharge disposition, length of stay (LOS), and functional ADL score for patients admitted to acute inpatient rehabilitation hospitals (IRH) during the COVID-19 pandemic and to compare these parameters to a period prior to the pandemic.\n \n Design\n Retrospective cohort study via systematic retrospective chart review of consecutive patients admitted to IRH from 1/1-2/19/2020 (pre-COVID-19T) and 4/1-5/9/2020 (COVID-19T).\n \n Setting\n System of three IRHs in the Northeastern United States.\n \n Participants\n Pre-COVID-19T, n=739; COVID-19T, n=335, of which COVID+ n =139 and COVID- n=196.\n \n Outcome Measure(s)\n Discharge Disposition, LOS, and Functional ADL scores\n \n Results\n COVID-19T patients were younger (p=0.03) and less likely to be White (p=0.03), and had a higher Case Mix Index (CMI) (p<0.01), longer acute care LOS (p<0.01) and IRH LOS (p<0.01). Patients that were COVID+ (during COVID-19T) were less likely to be White (p<0.01), had lower CMI (p<0.01), higher admission and discharge functional ADL score scores (p=0.02, p<0.01), and longer acute care LOS compared to those COVID- (p<0.01). There were no differences in discharge outcomes between pre-COVID-19T and COVID-19T cohorts (p=0.75), including when stratified for COVID-19 status (p=0.74). Functional ADL scores on admission and discharge were lower in COVID-19T than pre-COVID-19T (p=0.01), including when stratified for COVID-19 status though not significant (p=0.06).\n \n Conclusions\n 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 and supports the importance of IRHs to restore function and discharge patients to home, even with a more medically complex COVID-19 pandemic population.\n