Discharge disposition from model spinal cord injury care system rehabilitation programs

Objective: To identify and quantify factors associated with discharge to a nursing home for people with spinal cord Injuries. Design: Case control within a cohort of spinal cord injured persons. Setting: Model spinal cord injury care systems throughout the United States. Patients: A total 16,633 patients consecutively discharged alive between 1973 and 1996 who were admitted to the model system within 1 year of injury, who were both injured in and resided in the catchment area of the model system, and who were discharged to either a nursing home or a community residence. Main Outcome Measure: Discharge disposition. Results: Overall, 4.3% of patients were discharged to a nursing home. Factors that were significantly associated (p < .0001) with place of discharge were age, race, employment status at injury, bladder management method at discharge, education level, marital status, Frankel grade, functional independence in performing activities of daily living, independent ambulation, geographic region, neurologic level of injury, ventilator dependency, and third-party sponsor of rehabilitation. A multivariate predictive model was developed from these factors and was both 78% sensitive and specific in identifying patients who were discharged to a nursing home. Conclusions: Knowing the probability of nursing home placement can assist in evaluating the success of a rehabilitation program by allowing adjustment for case-mix differences across facilities. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.