title: Evaluating use of the Siebens Domain Management Model during inpatient rehabilitation to increase functional independence and discharge rate to home in stroke patients.
abstract: OBJECTIVE
  To evaluate use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home.
  
  
  METHODS
  Before and after study.
  
  
  METHODS
  IR facility.
  
  
  METHODS
  Before the intervention: 154 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2010; on average, they were admitted 9.1 days after receiving acute care. After the intervention: 151 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2012; on average they were admitted 7.3 days after receiving acute care. The comorbidity tier severity and prestroke living setting and living support appeared to be similar in both the preintervention and postintervention groups.
  
  
  METHODS
  Use of the SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home including medical/surgical issues, cognitive/emotional coping issues, physical function, and living environment/community re-entry needs.
  
  
  METHODS
  Use of Functional Independence Measure (FIM) score change during IR length of stay (LOS; FIM-LOS efficiency) and rates of discharge to community/home, acute care, and long-term care (LTC) to compare 2010/preintervention data with postintervention data from 2012, along with comparison of facility data to national aggregate data from the Uniform Data System for Medical Rehabilitation (UDSMR) for both years.
  
  
  RESULTS
  Preintervention 2010 FIM-LOS efficiency was 1.44 compared with a 2012 postintervention FIM-LOS efficiency of 2.24, which was significant (t = 4.3; P < .0001). Comparison of the UDSMR 2012 national FIM-LOS efficiency score (1.72) to the 2012 postintervention score of 2.24 reached significance (t = 2.6; P < .01). In addition, a significant difference was found between groups for discharge location: In the preintervention group, 57.8% were discharged to home/community, 14.9% to LTC, and 27.3% back to acute care compared with the postintervention group, in which 81.2% were discharged to home/community, 9.4% to LTC, and 9.4% back to acute care (χ(2) = 8.98; P < .001). Also significant was comparison between the 2012 postintervention group and the 2012 national UDSMR data for the same 3 discharge locations (χ(2) = 3.94; P < .05). Comparison of 2010 to 2012 facility data then shows a 23.4% increase in discharge to the community compared with an increase of 5.8% for the UDSMR 2010 to 2012 data, representing a community discharge rate that is 4 times greater for the 2012 facility postintervention group (χ(2) = 83.596; P < .0001).
  
  
  CONCLUSIONS
  Use of the SDMM during stroke IR may convey improvement in functional independence and is associated with an increased discharge rate to home/community and a reduction in institutionalization and acute-care transfers.
authors.affiliation: Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33189(∗). Electronic address: dkushner@med.miami.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Kushner
authors.affiliation: HealthSouth Rehabilitation Hospital, Miami, FL(†).
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Peters
authors.affiliation: Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33189(‡).
authors.forename: Doug
authors.initials: D
authors.lastname: Johnson-Greene
mesh_terms: D002545:Brain Ischemia / Q000534:rehabilitation; D015897:Comorbidity; D065187:Controlled Before-After Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000534:rehabilitation; D007902:Length of Stay; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D012046:Rehabilitation / Q000458:organization & administration*; D020379:Risk Adjustment; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation