title: Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities.
abstract: To describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation, and examine the independent effects of social support on deviations from expected lengths of stay.
  
  
  
  Retrospective cohort study.
  
  
  
  Inpatient rehabilitation facilities.
  
  
  
  Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 after stroke, lower extremity fracture, or lower extremity joint replacement.
  
  
  
  Not applicable.
  
  
  
  Relative length of stay (actual minus expected). The Centers for Medicare & Medicaid Services posts annual expected lengths of stay based on patients' clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none.
  
  
  
  Mean ± SD actual lengths of stay for joint replacement, fracture, and stroke were 9.8±3.6, 13.8±4.5, and 15.8±7.3 days, respectively; relative lengths of stay were -1.2±3.1, -1.6±3.7, and -1.7±5.2 days. Nearly half of patients (47%-48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (P<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement.
  
  
  
  Inpatient rehabilitation experiences and outcomes can be substantially affected by a patient's level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures.
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
authors.forename: Zakkoyya H
authors.initials: ZH
authors.lastname: Lewis
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
authors.forename: Catherine Cooper
authors.initials: CC
authors.lastname: Hay
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX. Electronic address: jegraham@utmb.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Graham
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lin
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
authors.forename: Amol M
authors.initials: AM
authors.lastname: Karmarkar
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000534:rehabilitation; D005260:Female; D050723:Fractures, Bone / Q000534:rehabilitation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012944:Social Support; D012959:Socioeconomic Factors; D000071939:Stroke Rehabilitation; D014481:United States
keywords: Length of stay; Rehabilitation; Social support