Functional and economic outcomes of cardiopulmonary patients: a preliminary comparison of the inpatient rehabilitation and skilled nursing facility environments.

Abstract

To examine the major clinical and economic outcomes of cardiopulmonary patients referred for inpatient rehabilitation or skilled nursing care after an acute care stay. Retrospective, exploratory study conducted at inpatient rehabilitation facilities (IRF) and a matched skilled nursing facility (SNF). Participants were cardiovascular and pulmonary patients (n = 495; 76.2 +/- 0.5 yrs). Measurements included changes in functionality (assessed by functional independence measure [FIM] and minimum data set [MDS]), length of stay (LOS), total and itemized facility charges, discharge disposition, and mortality. Participation in physical and occupational therapies occurred during 72-78% and 48-51% of total days in the IRF and SNF, respectively (P < 0.001). Changes in eating, grooming, bathing, dressing, toileting, bed-chair transfers, walking, verbal expression, problem solving, and auditory comprehension were greater in patients from the IRF than SNF (all P < 0.0001). LOS was longer in the SNF than IRF (34.7 +/- 3.4 vs. 14.9 +/- 0.5 days, P < 0.0001). In the IRF compared with the SNF, total charges ($22,162 vs. $10,873), pharmacy charges ($3104 vs. $1604), and combined physical and occupational therapy charges were higher ($5225 vs. $3582), all P < 0.0001. More IRF patients than SNF patients were discharged home (77.5% vs. 44.1%), and fewer IRF patients than SNF patients were discharged to acute care (15.8% vs. 23.2%) or expired (1.3% vs. 13.6%) during their stay (P < 0.05). More patients achieved functional independence, had shorter LOS, and had a higher rate of homebound discharge in the IRF than in the SNF, and this is associated with a higher cost of care. These SNF outcomes may be related to advancing age, type of illness, dementia, and inability to fully participate in therapies.