| Description |
Hospital care providers face challenges in identifying the most appropriate discharge disposition location for a patient. The most important factors to consider in this decision are not known. The purpose of this dissertation was to test whether physical function measured in the hospital is a useful metric by testing its association with discharge disposition itself, and with posthospital patient outcomes for patients discharged to a skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), or home. Few studies have sought to identify the factors that most significantly contribute to appropriate discharge disposition recommendations. Historical data for patients discharged from University of Utah Health (UUH) hospitals were used to test for an association between their physical function (PF) status at hospital admission and their discharge disposition. While this association was statistically significant, it was found to be stronger for variables like primary payer and admitting diagnosis. The outcomes that patients achieve in post-acute care (PAC) settings are important to consider in determining whether the most appropriate setting was utilized. Therefore, these outcomes were described for patients discharged to either a SNF or an IRF. The association between hospital-measured PF and the patient's PAC outcomes was tested. Results indicated that patients with higher PF in the hospital demonstrated shorter PAC length of stay. In the SNF, these patients had attenuated functional recovery iv compared to those with poorer PF in the hospital. In the IRF, higher PF in the hospital was associated with increased likelihood of discharge from the IRF to the community and decreased risk of additional hospital care (either an emergency department visit or rehospitalization) in the 30 days following hospital discharge. Finally, for patients discharged from an UUH hospital directly to home, PF across the continuum of care was characterized in order to illuminate the trajectory of patients' function across this care transition. Only a small proportion of patients achieved a threshold of PF consistent with community living. A higher level of PF measured in the hospital was associated with a greater likelihood of achieving this threshold. In summary, these studies aimed to determine the potential contribution of standardized PF measures in guiding discharge disposition decisions. |
