Implementation of a Cancer Pathway for Acute Rehabilitation in an Inpatient Rehabilitation Facility

Research Objectives: Examine patient-level clinical outcomes associated with implementation of a cancer pathway program in an inpatient rehabilitation facility (IRF)

Design: Observational pre-post descriptive study

Setting: One free-standing 60 bed IR

Participants: Patients with cancer diagnosis (active or history of) admitted for acute inpatient rehabilitation.

Interventions: A cancer pathway was created by the interdisciplinary rehabilitation team (physician, advanced practice provider, nursing, therapy, and case management) consisting of three tracks: supportive, restorative, and transitional. Patients were stratified into one of the three tracks prior to admission based on clinical characteristics such as medical and functional prognosis, expected functional goals and the targeted length of stay (LOS). Patients in the restorative pathway have a favorable medical and functional prognosis. Transitional pathway patients generally have active cancer and are preparing to undergo cancer treatment with an anticipated shorter LOS. Patients in the supportive pathway have poorer medical and functional prognosis and the emphasis of care is on family training and a short LOS to return home. Patients in the supportive and transitional tracks had a family care conference within the first 3 days of the IRF admission and if indicated were placed on a nursing supervisor watch board for closer monitoring. All cancer patients were discussed in a weekly interdisciplinary team conference to facilitate rehab course.

Main Outcome Measures: IRF length of stay (LOS), proportion readmitted to hospital, proportion discharged to community, and change in ambulation status (according to admission and discharge GG scores).

Results: The 11-month pre-implementation period included 79 patients, compared to 203 in the 12 months post, a 1.5-fold increase. In the post-period, medical complexity increased significantly (case mix index of 1.49 to 1.55) and there were slight increases in LOS (12.8 to 13.1 days), proportion readmitted (20.2% to 21.0%), and proportion discharged to community (67.9% to 69.0%). Ambulation was significantly improved (26.3 to 34.9)

Conclusions: The implementation of a cancer pathway in an IRF increased the number and the acuity of cancer patients accepted for acute rehabilitation and improved functional outcomes.

Author(s) Disclosures: None