Evaluating use of the Siebens domain management model during inpatient rehabilitation to increase functional independence and discharge rate to home in stroke patients

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Study evaluated the use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home. The SDMM involved weekly adjustments of IR care focused on potential barriers to discharge home including medical/surgical issues, cognitive/emotional coping issues, physical function, and living environment/community re-entry needs. This study entailed a comparison of pre-intervention and post-intervention participant outcome metrics for the purpose of assessing the use of SDMM in stroke IR. The pre-intervention group included 154 patients with ischemic/hemorrhagic strokes who were, on average, admitted to an IR facility 9.1 days after receiving acute care in 2010. The post-intervention group included 151 patients with ischemic/hemorrhagic strokes who were, on average, admitted to IR 7.3 days after receiving acute care in 2012. Results showed that pre-intervention Functional Independence Measure (FIM) score change during IR length of stay (FIM-LOS efficiency) was 1.44 and post-intervention FIM-LOS efficiency of 2.24, which was significant. Comparison of the 2012 Uniform Data System for Medical Rehabilitation (UDSMR) national FIM-LOS efficiency score (1.72) to the post-intervention score of 2.24 also reached significance. In the pre-intervention group, 57.8 percent were discharged to home/community, 14.9 percent to long-term care (LTC), and 27.3 percent back to acute care whereas in the post-intervention group, 81.2 percent were discharged to home/community, 9.4 percent to LTC, and 9.4 percent back to acute care. Comparison of 2010 to 2012 facility data then showed a 23.4 percent increase in discharge to the community compared with an increase of 5.8 percent for the UDSMR 2010 to 2012 data, representing a community discharge rate that is 4 times greater for the post-intervention group. Findings suggest that use of the SDMM during stroke IR may convey improvement in functional independence and is associated with an increased discharge rate to home/community and a reduction in institutionalization and acute-care transfers.

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