Examination of the dependency and complexity of patients admitted to in-patient rehabilitation in Australia
Duncan McKechnie A E , Julie Pryor B C , Murray J. Fisher B C and Tara Alexander DA Brain Injury Unit, Royal Rehab, PO Box 6, Ryde, Sydney, NSW 1680, Australia.
B Nursing Research and Development, Royal Rehab, PO Box 6, Ryde, Sydney, NSW 1680, Australia. Email: julie.pryor@royalrehab.com.au
C Susan Wakil School of Nursing and Midwifery, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia. Email: murray.fisher@sydney.edu.au
D Australasian Rehabilitation Outcomes Centre, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email: aroc@uow.edu.au
E Corresponding author. Email: duncan.mckechnie@royalrehab.com.au
Australian Health Review 44(1) 143-152 https://doi.org/10.1071/AH18073
Submitted: 12 April 2018 Accepted: 15 October 2018 Published: 18 January 2019
Abstract
Objective The aim of this study was to determine whether there has been a measurable change in the dependency and complexity of patients admitted to in-patient rehabilitation in Australia between 2007 and 2016.
Methods A retrospective cohort study design was used to examine in-patient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database for the period 2007–16. Epidemiological descriptive analysis was used to examine datasets for difference between four discrete years (2007, 2010, 2013 and 2016). Datasets included patient demographics, length of stay (LOS), comorbidities, complications and the Functional Independence Measure (FIM™).
Results Between 2007 and 2016, rehabilitation in-patients as a whole: (1) had a mean decrease in total admission FIM score; (2) became more complex, as evidenced by the increased proportion of particular comorbidities impacting on rehabilitation, namely cardiac and respiratory disease, dementia, diabetes and morbid obesity; and (3) had a mean decrease in total discharge FIM score. However, there was an increase in the proportion of patients discharged home from rehabilitation (from 86.5% to 92%) and decreases in onset and rehabilitation LOS of 2.2 and 2.5 days respectively.
Conclusion The dependency and complexity of patients admitted to in-patient rehabilitation in Australia has increased between 2007 and 2016.
What is known about the topic? Anecdotal reports suggest that rehabilitation patients in Australia have become more complex, necessitating increased active management of their presenting health condition and comorbid health conditions. However, to date, no systematic investigation has been undertaken to examine trends in rehabilitation in-patient dependency and complexity over time.
What does this paper add? This study provides measurable evidence of increased dependency and complexity in patients admitted to rehabilitation in Australia. Further, compared with 2007, rehabilitation in-patients as a whole had an increased burden of care on discharge from rehabilitation in 2016.
What are the implications for practitioners? The changes in patient dependency and complexity reported in this study have implications for rehabilitation service delivery. This is because the increased need for illness or injury and comorbidity management may result in increased potential for acute complications and health deterioration, and compensatory care for patients during rehabilitation. Clinicians may need to widen their skill set to include more acute and chronic illness management.
References
[1] Australian Institute of Health and Welfare (AIHW). Australia’s health 2016. Australia’s health series no. 15. Catalogue no. AUS 199. Canberra: AIHW; 2016.[2] Australian Institute of Health and Welfare (AIHW). Admitted patient care 2015–16: Australian hospital statistics. Health services series no. 75. Catalogue no. HSE 185. Canberra: AIHW; 2017.
[3] Green J, Gordon R, Kobel C, Blanchard M, Eagar K. AN-SNAP V4 User Manual. Wollongong: Centre for Health Service Development, University of Wollongong; 2015. Available at: https://ahsri.uow.edu.au/content/groups/public/@web/@chsd/@aroc/documents/doc/uow194637.pdf [verified 6 December 2018].
[4] Australasian Rehabilitation Outcomes Centre (AROC) 15 years of AROC – part 2: have rehabilitation patient characteristics changed over the past 10 years? JARNA 2017; 20 22–38.
[5] Australasian Rehabilitation Outcomes Centre (AROC). AROC impairment codes guidelines. Wollongong: AROC; 2007.
[6] Australian Bureau of Statistics (ABS). National health survey: first results, 2014–15. ABS Catalogue no. 4364.0.55.001. Canberra: ABS; 2015.
[7] Australian Institute of Health and Welfare (AIHW). National health data dictionary: version 16.2. Catalogue no. HWI 131. Canberra: AIHW; 2015.
[8] Cameron ID, Kurrle SE. Rehabilitation and older people. Med J Aust 2002; 177 387–91.
| 12358585PubMed |
[9] Pryor J, Fisher M. Nursing management of illness, injury and complications in rehabilitation. JARNA 2016; 19 19–30.
[10] Giaquinto S, Palma E, Maiolo I, Piro MT, Roncacci S, Sciarra A, Vittoria E. Importance and evaluation of comorbidity in rehabilitation. Disabil Rehabil 2001; 23 296–9.
| Importance and evaluation of comorbidity in rehabilitation.Crossref | GoogleScholarGoogle Scholar | 11354582PubMed |
[11] Patrick L, Knoefel F, Gaskowski P, Rexroth D. Medical comorbidity and rehabilitation efficiency in geriatric inpatients. J Am Geriatr Soc 2001; 49 1471–7.
| Medical comorbidity and rehabilitation efficiency in geriatric inpatients.Crossref | GoogleScholarGoogle Scholar | 11890585PubMed |
[12] Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968; 16 622–6.
| 5646906PubMed |
[13] Nolan M, Power D, Long J, Horgan F. Frailty and its association with rehabilitation outcomes in a post-acute older setting. Int J Ther Rehabil 2016; 23 33–40.
[14] Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173 489–95.
| A global clinical measure of fitness and frailty in elderly people.Crossref | GoogleScholarGoogle Scholar | 16129869PubMed |
[15] Kabboord AD, van Eijk M, Fiocco M, van Balen R, Achterberg WP. Assessment of comorbidity burden and its association with functional rehabilitation outcome after stroke or hip fracture: a systematic review and meta-analysis. J Am Med Dir Assoc 2016; 17 1066.e13–1066.e21.
[16] World Health Organization (WHO). International classification of functioning, disability and health: ICF. Geneva: WHO; 2001.
[17] Turner-Stokes L, Tonge P, Nyein K, Hunter M, Nielson S, Robinson I. The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation. Clin Rehabil 1998; 12 304–18.
| The Northwick Park Dependency Score (NPDS): a measure of nursing dependency in rehabilitation.Crossref | GoogleScholarGoogle Scholar | 9744666PubMed |
[18] Williams H, Harris R, Turner-Stokes L. Northwick Park Care Needs Assessment: adaptation for inpatient neurological rehabilitation settings. J Adv Nurs 2007; 59 612–22.
| Northwick Park Care Needs Assessment: adaptation for inpatient neurological rehabilitation settings.Crossref | GoogleScholarGoogle Scholar | 17645493PubMed |
[19] Alexandrescu R, Siegert RJ, Turner-Stokes L. The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset. Disabil Rehabil 2015; 37 1976–83.
| The Northwick Park Therapy Dependency Assessment scale: a psychometric analysis from a large multicentre neurorehabilitation dataset.Crossref | GoogleScholarGoogle Scholar | 25598001PubMed |
[20] Turner-Stokes L, Disler R, Williams H. The Rehabilitation Complexity Scale: a simple, practical tool to identify ‘complex specialised’ services in neurological rehabilitation. Clin Med (Lond) 2007; 7 593–9.
| The Rehabilitation Complexity Scale: a simple, practical tool to identify ‘complex specialised’ services in neurological rehabilitation.Crossref | GoogleScholarGoogle Scholar | 18193708PubMed |
[21] Turner-Stokes L, Scott H, Williams H, Siegert R. The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs. Disabil Rehabil 2012; 34 715–20.
| The Rehabilitation Complexity Scale – extended version: detection of patients with highly complex needs.Crossref | GoogleScholarGoogle Scholar | 22115200PubMed |
[22] Simmonds F, Stevermuer T. The AROC annual report: the state of rehabilitation in Australia 2005. Aust Health Rev 2007; 31 S31–53.
| The AROC annual report: the state of rehabilitation in Australia 2005.Crossref | GoogleScholarGoogle Scholar | 17402904PubMed |
[23] Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1987; 1 6–18.
| 3503663PubMed |
[24] Koh GC-H, Chen CH, Petrella R, Thind A. Rehabilitation impact indices and their independent predictors: a systematic review. BMJ Open 2013; 3 e003483
| Rehabilitation impact indices and their independent predictors: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[25] Australian Institute of Health and Welfare (AIHW). Risk factors contributing to chronic disease. Catalogue no. PHE 157. Canberra: AIHW; 2012.
[26] Fakolade A, Bisson EJ, Pétrin J, Lamarre J, Finlayson MA. Effect of comorbidities on outcomes of neurorehabilitation interventions in multiple sclerosis: a scoping review. Int J MS Care 2016; 18 282–90.
| Effect of comorbidities on outcomes of neurorehabilitation interventions in multiple sclerosis: a scoping review.Crossref | GoogleScholarGoogle Scholar | 27999522PubMed |
[27] Pryor J. Person-centred rehabilitation: is it really happening? JARNA 2017; 20 2–3.
[28] Wade D. Rehabilitation – a new approach. Part one: the problems. Clin Rehabil 2015; 29 1041–50.
| Rehabilitation – a new approach. Part one: the problems.Crossref | GoogleScholarGoogle Scholar | 26467940PubMed |
[29] McPherson K. Rehabilitation nursing – a final frontier? Int J Nurs Stud 2006; 43 787–9.
| Rehabilitation nursing – a final frontier?Crossref | GoogleScholarGoogle Scholar | 16843467PubMed |
[30] Pryor J. A grounded theory of nursing’s contribution to inpatient rehabilitation. Ph.D. Thesis, Deakin University, Melbourne; 2005. Available at: http://dro.deakin.edu.au/view/DU:30023256 [verified 28 November 2018].
[31] Antoinette T. Neurorehabilitation nursing of persons with TBI: from injury to recovery. In: Zasler ND, Katz DI and Zafonte RD, editors. Brain injury medicine: principles and practice. New York: Demos Medical Publishing; 2007. pp. 743–65.
[32] Bejor M, Ramella FC, Toffola ED, Comelli M, Chiappedi M. Inpatient rehabilitation outcome: a matter of diagnosis? Neuropsychiatr Dis Treat 2013; 9 253–7.
| Inpatient rehabilitation outcome: a matter of diagnosis?Crossref | GoogleScholarGoogle Scholar | 23550109PubMed |
[33] Press Y, Grinshpun Y, Berzak A, Friger M, Clarfield AM. The effect of co-morbidity on the rehabilitation process in elderly patients after hip fracture. Arch Gerontol Geriatr 2007; 45 281–94.
| The effect of co-morbidity on the rehabilitation process in elderly patients after hip fracture.Crossref | GoogleScholarGoogle Scholar | 17350698PubMed |
[34] Bennett CC. Are we there yet? A journey of health reform in Australia. Med J Aust 2013; 199 251–5.
| Are we there yet? A journey of health reform in Australia.Crossref | GoogleScholarGoogle Scholar | 23984781PubMed |
[35] Considine J, Street M, Botti M, O’Connell B, Kent B, Dunning AMT. Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care. Aust Health Rev 2015; 39 387–94.
| Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care.Crossref | GoogleScholarGoogle Scholar | 25751595PubMed |
[36] Bowman M, Faux S. Outcomes of an inpatient rehabilitation program following complicated cardio-pulmonary transplantation. Int J Phys Med Rehabil 2013; 1 152
| Outcomes of an inpatient rehabilitation program following complicated cardio-pulmonary transplantation.Crossref | GoogleScholarGoogle Scholar |
[37] Burke RE, Whitfield EA, Hittle D, Min SJ, Levy C, Prochazka AV, Coleman EA, Schwartz R, Ginde AA. Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes. J Am Med Dir Assoc 2016; 17 249–55.
| Hospital readmission from post-acute care facilities: risk factors, timing, and outcomes.Crossref | GoogleScholarGoogle Scholar | 26715357PubMed |
[38] Middleton A, Graham JE, Deutsch A, Ottenbacher KJ. Potentially preventable within-stay readmissions among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation. PM R 2017; 9 1095–105.
| Potentially preventable within-stay readmissions among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation.Crossref | GoogleScholarGoogle Scholar | 28477958PubMed |
[39] Australasian Rehabilitation Outcomes Centre (AROC) 15 years of AROC – part 1: history of AROC. JARNA 2017; 20 32–3.
