title: Use of a standardized assessment to predict rehabilitation care after acute stroke.
abstract: OBJECTIVE
  To pilot a program of formal assessment of rehabilitation needs and predictors of referral to rehabilitation.
  
  
  METHODS
  A prospective pilot project to collect standardized measures of stroke severity and function: National Institutes of Health Stroke Scale, premorbid modified Rankin scale, Short Portable Mental Status Questionnaire, and Barthel Index (BI). These were collected in addition to routine data in the Get With The Guidelines-Stroke registry. Logistic regression was used to examine predictors of referral to any institution-based rehabilitation versus discharge home and referral to an inpatient rehabilitation facility (IRF) versus a skilled nursing facility (SNF).
  
  
  METHODS
  Twenty-two hospitals within the Northeast Cerebrovascular Consortium (located in the northeastern United States).
  
  
  METHODS
  Data were collected on individuals with acute ischemic and hemorrhagic stroke (N=736).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Discharge disposition location.
  
  
  RESULTS
  The BI score was recorded in 736 (81%) patients. In multivariable analyses, a higher BI score (85-100) was the only factor associated with return home versus need for institution-based rehabilitation (P<.001). Among patients discharged to IRF versus SNF, discharge to IRF was less likely in older patients (odds ratio [OR], .96; confidence interval [CI], .94-.98; P<.001) and in those with prestroke disability (modified Rankin scale score, 2-5) (OR, .47; CI, .28-.78; P=.004) and more likely in those with moderate-severe (BI score, 25-40; OR, 3.26; CI, 1.45-7.30; P=.004) or moderate (BI score, 45-60; OR, 2.47; CI, 1.17-5.21; P=.018) activities of daily living (ADL) impairment.
  
  
  CONCLUSIONS
  Formal standardized assessment of rehabilitation needs was feasible in this pilot project. Patients' sociodemographic characteristics, premorbid function, and ADL impairment discriminated better between discharge home and institution-based rehabilitation than between IRF and SNF. Selection of IRF versus SNF appears to be influenced either by unmeasured clinical characteristics of individuals with stroke or by nonclinical factors, such as cost, geography, referral relationships, or IRF availability.
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY; Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY; New York-Presbyterian Hospital, New York, NY. Electronic address: JS1165@columbia.edu.
authors.forename: Joel
authors.initials: J
authors.lastname: Stein
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: Gaylord Specialty Healthcare, Wallingford, CT.
authors.forename: Alyse
authors.initials: A
authors.lastname: Sicklick
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ.
authors.forename: Robin
authors.initials: R
authors.lastname: Hedeman
authors.affiliation: American Heart Association/American Stroke Association - Founders Affiliate, Albany, NY.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Magdon-Ismail
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010351:Patient Discharge; D010865:Pilot Projects; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities; D000071939:Stroke Rehabilitation
keywords: Outcomes; Rehabilitation; Stroke