PR_287Association of Function and Postdischarge Mortality in Stroke Patients

Objective: To explore the factors associated with increase in mortality. Design: Retrospective cohort study from 1995 through 2001 using information submitted to the Uniform Data System for Medical Rehabilitation. Follow-up data were collected by the National Follow-up Services between 80 and 180 days after discharge using telephone interviews. Setting: Inpatient medical rehabilitation hospitals. Participants: Data were analyzed from 744 inpatient medical rehabilitation hospitals and centers located in 48 U.S. states. A total of 48,057 patient records with stroke were examined. Patients’ mean age ± SD was 69.8±12.7 years; the sample was 52% female and 77% non-Hispanic white. 43.6% of the patients had left body stroke. Intervention: Not applicable. Main Outcome Measures: Admission and discharge function (assessed by FIM) change in functional status (assessed by FIM change), and mortality at 80 to 180 days postdischarge. Results: Postdischarge mortality increased from 1.9% in 1995 to 6.8% in 2001. The factors associated with increased mortality were FIM change (odds ratio [OR]=.98), discharge FIM (OR=.98), age (OR=1.01), and length of stay (LOS) (OR=.99). Patients who were alive at follow-up did not show any significant change in age, FIM, and FIM change from 1995 to 2001. Patients who were dead at follow-up showed only a slight increase in age (from 70 to 74y), and a marked decrease in admission FIM (from 66 to 55), discharge FIM (89 to 68), and FIM change (23 to 13). LOS decreased significantly in both groups. Conclusions: Decreases in FIM and FIM change scores are the most important factors associated with increased mortality. Increase in age and decrease in LOS are also associated with increased mortality.