Social support and actual versus expected length of stay in inpatient rehabilitation facilities

Abstract Objectives Describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation and examine the independent effects of social support on deviations from expected lengths of stay. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities across the United States. Participants Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 following stroke, lower extremity fracture, or lower extremity joint replacement. Intervention Not applicable. Main Outcome Measure Relative length of stay (actual – expected). The Centers for Medicare and Medicaid Services posts annual expected lengths of stay based on patients’ clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. Results Mean (SD) actual lengths of stay for joint replacement, fracture, and stroke were 9.8 (3.6), 13.8 (4.5), and 15.8 (7.3) days, respectively; relative lengths of stay were -1.2 (3.1), -1.6 (3.7), and -1.7 (5.2) days. Nearly half of patients (47-48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (p