The stages of the proposed disability staging system will be developed to reflect common patterns of functional recovery with higher stages being associated with the capacity of the patient to live with greater independence in the community. Each stage will be mapped into those environmental/caregiver situations which allow a patient to return to the community given the achievement of that particular stage. The system will also predict the likelihood of status decline (defined as lower functional status at discharge compared to admission, discharge to an acute hospital, or death while on the rehabilitation service). Data for this study will be drawn from the Uniform Data System (UDS) for medical rehabilitation which is used to collect data on patient demographics, diagnoses, psychosocial circumstance, and severity of disability from more than 342 inpatient rehabilitation units and free standing hospitals in 49 states. The staging system will be developed from patient discharges from these facilities spanning the years 1992 to 1995. This data set will provide over 400 patient discharges. Statistical analysis will be mostly exploratory and descriptive. A cross-sectional split sample will be used followed by prospective validation of the staging systems using data drawn from later time periods. Models will be developed that allow comparison between simple classification trees and more complex logistic regression indices. The trees and indices will allow for diagnosis, type and severity of disability at admission, patient age, time since onset of disability, and sociodemographic factors. A parallel set of indices will adjust predicted probabilities assuming changes in length of stay. The quantitative analyses will be supplemented with information derived from expert panels. Six specific hypotheses are outlined which will be tested in this study: 1) that outcomes for patients with certain diagnoses will tend to cluster at certain stages; 2) within each diagnostic category, the achievement of any stage of functional independence will depend primarily on the type and severity of disability at admission; 3) patients who are younger have shorter time since onset of disability, were employed prior to hospitalization, or living alone, or living in the community in other than a nursing home prior to hospitalization will have increased likelihoods of achieving higher stages of functional independence; 4) patients who are older and those who present with greater severity of disability will be at an increased risk for status decline during rehabilitation; 5) the predictive associations among patient traits and the achievement of any stage will be constant after counting for variations in rehabilitation length of stay (longer length of stay increases the likelihood of achieving a higher stage); and 6) patients with rehabilitation interruptions and a larger number of coded diagnoses at discharge will be less likely to achieve higher stages of discharge and more likely to suffer status decline.
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