Functional and Economic Outcomes of Cardiopulmonary Patients

OBJECTIVE: To examine the major clinical and economic outcomes of cardiopulmonary patients referred for inpatient rehabilitation or skilled nursing care after an acute care stay. DESIGN: 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. RESULTS: 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). CONCLUSIONS: 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.