Creation of a Rehabilitation Prediction Rule: a Prioritization Procedure

Older adults may require longer recovery periods prior to being discharged from the hospital after an acute care stay. For some, returning to their previous living arrangement may no longer be safe or feasible after an acute care admission, and they may require alternate levels of care. It can be challenging to evaluate which patients may benefit most from inpatient rehabilitation versus those for whom alternate levels of care are more suitable. Using a prioritization procedure, this study identified and ranked predictive factors for successful inpatient rehabilitation (defined as discharge to previous living arrangement) from most to least important. The final round of the prioritization procedure resulted in a list of the top 20 predictive factors, ranked by health-care providers in the field, from most to least important. Predictive factors included demographic information, past medical history factors, acute care illness factors, and results of investigations performed during the index hospitalization. The top ranked predictive factors related to patients' previous living arrangements, level of independence before hospitalization, and presence or absence of cognitive impairment. The bottom ranked predictive factors related to physical measures and results of inpatient investigations at the time of transfer. These findings highlight the importance of considering patients' lived experiences prior to hospitalization when determining who may obtain the greatest benefit from further, intensive inpatient rehabilitation following an acute care hospitalization.