Interaction effects between rehabilitation and discharge destination on inpatients' functional abilities.

A patient's functional ability after hospital discharge may be influenced by in-hospital rehabilitation and discharge destination. However, we know very little about how in-hospital rehabilitation intervention interacts with the type of discharge destination or how this interaction influences patients' functional abilities. Thus, how an interaction between in-hospital rehabilitation and discharge destination influences a patient's subsequent functional ability was examined. This was a cross-sectional study whose participants were inpatients who underwent rehabilitation between February 2008 and December 2010 at a hospital in Japan (n = 835). Participants were categorized into three condition groups (i.e., stroke, orthopedic, disuse syndrome). Then, interaction effects between the rehabilitation therapy and the type of discharge destination on a patient's subsequent functional ability were estimated by hierarchical linear regression analysis in each of the three subgroups. In models where the dependent variable was Functional Independence Measure (FIM) score at 3 mo after hospital discharge, a significant interaction between rehabilitation potential (a measure based on the FIM effectiveness measure) and discharge destination (home or other) was observed in the stroke and orthopedic patients (both p < 0.001). These findings may be useful in deciding on discharge destinations for patients.

Predicting the length of hospital stay of psychiatry patients using signal detection analysis.

In Japan, the length of hospital stay (LOS) at psychiatric institutions often exceeds a year, and factors related to such stays have been identified. However, we do not know how multiple patient, hospital, and physician factors interact to determine LOS. Patient data were collected from a psychiatric hospital in Osaka, Japan. We developed subgroups, which were determined by interactions related to LOS using signal detection theory. In acute or emergency wards, five factors related to LOS were identified, and subjects were categorized into six subgroups. The indices obtained by the five factors ranged 2.49-3.47 for odds ratio, 0.47-0.84 for sensitivity, 0.40-0.76 for specificity, and 0.52-0.71 for positive predictive value. In general wards, five factors related to LOS were identified, and subjects were categorized into six subgroups. The indices obtained by the five factors ranged 3.02-5.36 for odds ratio, 0.58-0.86 for sensitivity, 0.37-0.68 for specificity, and 0.85-0.92 for positive predictive value. Psychiatrists who have been practicing longer in acute or emergency wards appear to have significantly longer stay of patients, and older or more severe patients tend to be in need of longer inpatient care. Our results provide findings that may be helpful in decreasing LOS at psychiatric hospitals.