Factors Associated With Discharge Destination in Advanced Cancer Patients With Bone Metastasis in a Japanese Hospital

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.

Survey of the Electronic Medical Recoding System Used in Kaifukuki Rehabilitation Wards / The Japanese Journal of Rehabilitation Medicine

A working group, established by the Japanese Board-certified Physiatrist Association to examine the necessary functions for an electronic medical record keeping system for rehabilitation, created a functional evaluation system for electronic medical record keeping in kaifukuki rehabilitation wards. The group conducted a survey to determine how electronic medical records are actually being used in kaifukuki rehabilitation wards. Methods : The group sent questionnaires to 153 hospitals with kaifukuki rehabilitation wards by mail. The questions included the period of usage, how satisfied they were with their system, and a self-evaluation form for their electronic medical record functional evaluation. They asked the respondents to evaluate each item from 1 to 5 points. Results : The group received answers from 82 institutions, with a valid answer rate of 53.6% in total. The median of the electronic record functional evaluation was 60.5 points. The points given varied from 1 to 5 in all items. Conclusion : It was determined that electronic medical records are equipped with a minimum of functions for rehabilitation, but also that there are great functional differences among institutions.