Association of referral source and acute care transfers from inpatient rehabilitation among patients with brain injury and stroke.

Background: Logistics of admissions to inpatient rehabilitation facilities have been reported to affect patient outcomes. One aspect that has not been previously assessed is the impact of referral source on outcomes.

Objective: The primary aim was to determine whether there is an association between referral source and the prevalence of acute care transfers. The secondary aim was to explore whether there is an association between referral source and functional improvement achieved with inpatient rehabilitation.

Design: Retrospective chart review.

Setting: Rehabilitation unit at a Veterans Affairs hospital.

Patients: Veterans with a diagnosis of stroke or brain injury who were initially admitted to the rehabilitation unit from 2019 to 2023 were included. Veterans were placed into the external referral group or the internal referral group.

Main outcome measures: Admission functional status measurement with Functional Independence Measure (FIM) scores and comorbidity measurement with Charlson Comorbidity Index (CCI) scores were submitted to independent t-tests to examine potential baseline differences between the two groups. To evaluate frequency of discharge outcomes, chi-square analysis was performed. To evaluate functional improvement during inpatient rehabilitation, FIM effectiveness was submitted to independent t-tests.

Results: 177 veterans were included, with 97 (54.8%) from external referrals and 80 (45.2%) from internal referrals. There were no baseline differences between the two groups in terms of admission FIM and CCI scores (p > .05). Although acute care transfer rates were higher for admissions from external referrals (17.5%) compared to those from internal referrals (11.3%), this difference was not statistically significant (p = .45). FIM effectiveness during inpatient rehabilitation was similar between the two groups.

Conclusions: Preliminary findings showed that referral source may not be a factor in acute care transfer frequency or functional improvement. It will be important for a multicenter study to replicate findings before drawing conclusions.