Increased mortality following discharge

A reduction by health insurance carriers in the number of treatment days covered in medical rehabilitation hospitals by nearly 40% during the past decade did not diminish treatment effectiveness, a study has found. However, the analysis revealed a disturbing trend: Patients were not living as long after discharge.

Researchers studied records of 148,897 patients treated in 744 inpatient medical rehabilitation hospitals in the U.S. between 1994 and 2001. They found that deaths between discharge and a six-month follow-up increased from less than one percent in 1994 to 4.7% in 2001.

Carl V. Granger, professor in the Department of Rehabilitation Medicine in the University at Buffalo (N.Y.) School of Medicine and Biomedical Sciences and senior author on the research, maintains the increase in mortality was unexpected and needs to be monitored.

"There have been dramatic changes throughout health care over the past decade, and all the factors affected by these changes are not included in the databases we examined," cautions Granger, emphasizing that this analysis includes data from rehabilitation hospitals only, because they routinely perform follow-up assessments after discharge. The outcomes for patients who received rehabilitation in other settings, such as home care, nursing homes, or outpatient clinics are unknown because they are not monitored systematically.

The analysis covered length of stay for five major impairment groups--stroke, brain dysfunction, other neurological conditions, spinal cord impairment, and orthopedics. Most significantly, the mean number of patients who died between discharge and follow-up increased in all groups. The largest jump in mortality occurred in those admitted for brain and spinal cord dysfunctions, while deaths in orthopedic patients remained fairly stable. There was no significant change in age at admission (patients admitted in 2001 actually were two years younger, on average, than in 1994), or the number or type of additional health problems.

Granger indicates that the researchers do not have an explanation for the increase in death. "Our examination for the possibilities that older age and/or more severe disability were a factor showed these variables to be rather stable, so they would not account for increased mortality."

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