Risk factors for death and emergency transfer in acute and subacute inpatient rehabilitation

Objectives: To compare the risk of death or emergency transfer(ET) to an acute care hospital for acute and subacute rehabilitation inpatients, to identify risk factors, and to determine whether the risk factors vary by level of care. Design: Proportional hazards regression analysis of retrospective cohort data. Explanatory variables included level of care, age, sex, medical stability at admission, and diagnosis. Setting: An acute inpatient rehabilitation hospital and a skilled nursing facility-based subacute rehabilitation program. Patients: Patients were selected from a database of all acute and subacute inpatients discharged between January 1992 and August 1993 (N = 4,755). Readmissions and pediatric patients were excluded (n = 896). Patients who had complete data (n = 3,185) were included in the survival analysis; a separate univariable analysis was performed for patients who lacked complete data (n = 673). Outcome Measure: Rate of death or emergency transfer during rehabilitation. Results: The overall risk was greater for subacute patients than for acute inpatients, 20.6% vs 11.6%, odds ratio = 2.0, CI = 1.6 to 2.5. The survival analysis indicated that age, level of care, sex, and stability were associated with the risk of death or emergency transfer (2.1 less than or equal to z less than or equal to 4.7; p <.05 for each). However, the difference in risk between subacute and acute care was greatest among younger patients. Conclusions: Careful consideration of risk factors is critical for proper assignment of patients to rehabilitation levels of care. However, research is needed to test these findings in other settings and to improve identification of high-risk patients. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation