Inpatient rehabilitation of patients requiring hemodialysis: improving efficiency of care

OBJECTIVE: To determine if reducing missed therapy sessions by patients requiring hemodialysis will reduce the length of stay (LOS) and improve the efficiency of care in an inpatient rehabilitation unit. DESIGN: Retrospective study. SETTING: Inpatient rehabilitation unit at a university medical center. PARTICIPANTS: All patients discharged from the Albany Medical Center rehabilitation unit between January 1, 2003, and June 30, 2004. The total number of patients was 955, 40 of whom required hemodialysis. INTERVENTION: On January 1, 2003, Albany Medical Center began providing hemodialysis in the late afternoon, allowing patients to complete a full 3-hour program without missing therapy sessions to attend dialysis. We compared the outcomes of 915 patients who did not require hemodialysis with the outcomes of 40 patients who required hemodialysis. We also compared the outcomes of patients treated on the rehabilitation unit in 2003-2004 to the outcomes of patients treated on the rehabilitation unit before dialysis was available at times that did not conflict with therapy (calendar year 2001). MAIN OUTCOME MEASURES: LOS, improvement on the FIM instrument, and FIM efficiency score. RESULTS: The LOS of the hemodialysis patients changed from 16.0 in 2001 to 12.1 in 2003-2004 (P<.05), and the FIM efficiency score of the hemodialysis patients improved from 1.8 in 2001 to 2.9 in 2003-2004 (P<.05). The FIM efficiency score of the nondialysis group in 2003-2004 was 4.0. This was significantly greater (P<.05) than that of dialysis patients in 2003-2004. CONCLUSIONS: A program to reduce conflicts between medical treatments such as hemodialysis and therapy sessions may result in reduced LOS and improved efficiency on an inpatient rehabilitation unit.     

Inpatient cancer rehabilitation: a retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients

Alam E, Wilson RD, Vargo MM. Inpatient cancer rehabilitation: a retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients.

Objective

To determine whether patients with diagnoses of neoplasm undergoing acute rehabilitation differ from other patients in frequency of acute care transfer and type of medical complications.

Design

Retrospective cohort analysis.

Setting

Acute rehabilitation hospital located within an academic medical center.

Participants

Patients with diagnosis of neoplasm (n=40) and patients without neoplasm (n=253) requiring transfer were identified from a database of 2801 rehabilitation discharges over nearly a 4-year period.

Interventions

Not applicable.

Main Outcome Measures

Frequency of unplanned transfer and reasons for the transfer.

Results

Significant difference occurred in overall rate of transfer between patients with neoplasm (21%) and controls (9.7%; P<.001). When evaluated separately for type of neoplasm (with patients receiving corresponding type of rehabilitation as controls), a significantly higher rate of transfer to acute care was found for brain tumor (25% vs 12%; P=.004) and spinal cord neoplasms (23% vs 10%; P=.009), but statistical significance was not reached for other tumor types (12.5% vs 7.4%; P=.19). Patients with stroke with neoplasm as a comorbidity, analyzed separately, with the other patients with stroke as controls, had significantly higher risk of transfer (22% vs 10%; P=.012). Logistic regression analysis found an odds ratio (OR) of 2.5 for unplanned transfer among patients with diagnosis of neoplasm (OR=2.5 for malignancy; OR=2.4 for benign neoplasm). Patients with neoplasm had infection as the most common reason for transfer (28% of the neoplasm transfers vs 18% of other transfers; P=.01), whereas in the nonneoplasm group, cardiopulmonary factors predominated (12% of patients with tumor vs 31% of patients without tumor transfers; P<.001).

Conclusions

In the present sample, patients with neoplasm were more likely to require transfer than patients without neoplasm, although this pattern did not reach statistical significance for noncentral nervous system cases. Overall, patients with neoplasm appear more likely than those without neoplasm to have an infectious cause for unplanned transfer. Increased awareness of this difference may lead to improved medical management on rehabilitation units.     

综合医院康复科住院患者分析

目的探讨综合医院康复科住院患者的疾病种类、患者来源、住院日和住院费用的特点。方法利用“广东省病案查询统计系统”回顾查询2004至2005年在康复科出院的全部病例1246例,统计分析患者的年龄、疾病诊断数、患者来源、平均住院日和住院费用。结果2005年出院患者平均年龄(61．2±13．7)岁；第一诊断脑梗死占40．4%,脑出血12．6%,颈椎病5．7%,脑外伤5．1%,骨折3．7%；患者平均患病病种(5．52±1．54)个；患者首次入院科室以康复科最多,占47．7%,转科患者占52．3%,其中神经内科26．4%,神经外科7．9%,骨科4．1%；人均住院时间为39．1 d,康复科入院患者23．7 d,神经内科入院患者44．4 d,骨科患者60．2 d,神经外科患者62．4 d；脑梗死患者人均住院时间为34．2 d,骨折63．5 d,颈椎病21．3 d,颅脑外伤64．2 d；人均住院总费用36 167．7元,其中药品费最高,占47．6%,其次是治疗费。颈椎病的费用最低,颅脑外伤最高。结论康复科住院患者病种多,人均患病数多,转科患者多,住院时间长,住院费用高,药品费比例过高。应该在患者转科前开展康复治疗,减少用药,才能缩短住院日,降低费用,减轻患者的负担。     

Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury

Qu H, Shewchuk RM, Chen Y, Deutsch A. Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury.

Objective

To examine the impact of Medicare's inpatient rehabilitation facility (IRF) prospective payment system (PPS) on inpatient rehabilitation outcomes for patients with traumatic spinal cord injury (SCI).

Design

Retrospective study.

Setting

Twelve SCI Model Systems.

Participants

A sample of Medicare (n=296) and non-Medicare (n=3110) patients was selected from the National SCI Statistical Center Database from 1996 to 2006.

Interventions

Not applicable.

Main Outcome Measures

Motor FIM score change and length of stay (LOS).

Results

LOS decreased by about 5.8 days a year (P<.001) for Medicare patients and about 1.3 days a year (P=.031) for non-Medicare patients after PPS implementation. However, for both groups, FIM score gains were not significantly different in the pre-PPS and PPS periods.

Conclusions

Although significant decreases in LOS were observed for Medicare patients after IRF PPS implementation, Medicare patients' improvements in motor function did not decrease. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient rehabilitation care before PPS implementation. IRF PPS implementation was associated with shorter stays, but was not associated with lower functional improvement.     

Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury

OBJECTIVE: To examine the association between time from injury to rehabilitation admission and outcomes for patients with traumatic brain injuries (TBIs). DESIGN: Retrospective chart review. SETTING: One hundred-bed inpatient rehabilitation facility with a 20-bed brain injury unit. PARTICIPANTS: Patients with TBIs discharged from initial inpatient rehabilitation between 2003 and 2004 (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcomes examined were functional independence at discharge (motor, cognitive, total FIM scores), rehabilitation length of stay (LOS), and rehabilitation cost. RESULTS: Significant linear trends were observed for time to admission and motor FIM scores, total FIM scores, rehabilitation LOS, and cost. All linear regression models contained time to admission as a significant predictor of rehabilitation outcomes. Over half of the variability in outcomes was explained by predictors including time to admission and case-mix group or individual FIM scores with the exception of discharge motor FIM score, for which only 45% of the variability was explained. CONCLUSIONS: Patients who progress to rehabilitation earlier do better functionally and have lower costs and shorter LOSs. Furthermore, the time to rehabilitation admission is easily calculated and could be used by rehabilitation providers in adjunct with admission FIM scores to estimate resource utilization.     

Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror

Sayer NA, Chiros CE, Sigford B, Scott S, Clothier B, Pickett T, Lew HL. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror.

Objective

To describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.

Design

Observational study based on chart review and Department of Veterans Affairs (VA) administrative data.

Setting

The 4 VA polytrauma rehabilitation centers (PRCs).

Participants

Service members (N=188) admitted to a PRC during the first 4 years of the Global War on Terror for injuries sustained during Operation Iraqi Freedom or Operation Enduring Freedom.

Intervention

Multidisciplinary comprehensive rehabilitation program.

Main Outcomes Measures

Cognitive and motor FIM instrument gain scores and length of stay (LOS).

Results

Most war-injured patients had traumatic brain injury, injuries to several other body systems and organs, and associated pain. Fifty-six percent had blast-related injuries, and the pattern of injuries was unique among those with injuries secondary to blasts. Soft tissue, eye, oral and maxillofacial, otologic, penetrating brain injuries, symptoms of post-traumatic stress disorder, and auditory impairments were more common in blast-injured patients than in those with war injuries of other etiologies. The mechanism of the injury did not predict functional outcomes. LOS was variable, particularly for those with blast injuries. Patients with low levels of independence at admissions made the most progress but remained more dependent at discharge compared with other PRC patients. The rate of gain was slower in this low-functioning group.

Conclusions

Blasts produce a unique constellation of injuries but do not make a unique contribution to functional gain scores. Findings underscore the need for assessment and treatment of pain and mental health problems among patients with polytrauma and blast-related injuries. Patients with polytrauma have lifelong needs, and future research should examine needs over time after community re-entry.     

Inpatient Stroke Rehabilitation Lengths of Stay in Canada Derived From the National Rehabilitation Reporting System, 2008 and 2009

Objective

To determine rehabilitation length of stay (LOS) for patients with stroke in Canada, and to evaluate which factors contribute to variations in LOS.

Design

A retrospective cohort study of Canadians rehabilitating from stroke using medical, functional, and sociodemographic variables extracted from the Canadian Institute for Health Information's National Rehabilitation Reporting System.

Setting

Canadian rehabilitation hospitals providing stroke rehabilitation services.

Participants

Patients with stroke (N=11,983) admitted to rehabilitation hospitals from January 2008 through December 2009.

Interventions

None.

Main Outcome Measures

Rehabilitation LOSs were calculated nationally and regionally. Regression models incorporating sociodemographic and clinical measures were constructed to test their effect on LOS.

Results

The median stroke rehabilitation LOSs was 35 days (quartiles: 20d, 54d). LOSs varied regionally within Canada. A multivariable regression model including age, FIM motor function scores at admission, and geographic region explained 20% of the variation in LOSs. Modeling these data using a Function-Related Groups case-mix model explained 16% of the variation in LOSs.

Conclusions

FIM motor function scores at admission along with age and geographic region best predicted rehabilitation LOS. These variables explained 20% of the variation in LOSs. Despite regional differences in LOSs, patient characteristics were similar between regions. Other nonpatient factors not captured in these data may contribute to a greater extent in determining stroke rehabilitation LOS.     

Comparison of postoperative rehabilitation in cancer patients undergoing internal and external hemipelvectomy

Guo Y, Fu J, Palmer JL, Hanohano J, Cote C, Bruera E. Comparison of postoperative rehabilitation in cancer patients undergoing internal and external hemipelvectomy.

Objective

To compare postoperative rehabilitation, functional outcome, and pain management in cancer patients who underwent an internal hemipelvectomy versus an external hemipelvectomy.

Design

Retrospective study.

Setting

Tertiary cancer center.

Participants

Patients (N=60) who underwent a hemipelvectomy between February 1996 and November 2005 were included in this study (30 internal hemipelvectomy patients and 30 external hemipelvectomy patients).

Interventions

Not applicable.

Main Outcome Measures

Hospital and rehabilitation length of stay (LOS), percentage of physiatrist consultation and inpatient rehabilitation, functional status of transfers and ambulation, and pain medication utilization.

Results

The rate of physiatrist consultation and acute rehabilitation admission were 15 (50%) of 30 and 13 (43%) of 30 for internal hemipelvectomy patients, and 16 (53%) of 30 and 16 (53%) of 30 for external hemipelvectomy patients. Median hospital LOS for external hemipelvectomy patients (37d) was significantly longer than for internal hemipelvectomy patients (19d) (P=0.004); median rehabilitation LOS was similar in both groups (20d for external hemipelvectomy patients versus 22 for internal hemipelvectomy patients; P=0.83). On discharge, 14 (47%) of 30 internal hemipelvectomy patients could ambulate without assistance, whereas only 5 (17%) of 30 external hemipelvectomy patients could do so (P=0.013). The median morphine equivalent daily dose at discharge for external hemipelvectomy patients (150mg) was significantly higher than that for internal hemipelvectomy patients (45mg) (P=0.032).

Conclusions

A similar percentage of internal hemipelvectomy and external hemipelvectomy patients were admitted to inpatient rehabilitation. External hemipelvectomy patients had longer hospital LOS, less favorable functional outcome, and required more intense treatment for pain.     

技能训练对男性精神分裂症病人康复效果的研究

目的:观察技能训练对精神分裂症病人阴性症状的康复效果。方法:将住院精神分裂症病人60例随机分成实验组与对照组各30例,观察6个月,以阴性症状评定量表(SANS)评定疗效。结果:实验组经3个月的技能训练后注意障碍分值下降,与对照组比较差异具显著性意义(P<0.01);训练6个月后情感平淡、兴趣缺乏、注意障碍都有明显改善,与对照组比较,差异具极显著性意义(P<0.01)。结论:技能训练对精神分裂症病人阴性症状的康复有一定的帮助。     

The diagnosis of cancer in the "roar" of potential cancer symptoms of patients in primary health care Research by means of the computerised journal

Objective - To describe the diagnostic work-up pattern in primary health care, aiming, with as few diagnostic activities as possible, to identify a number of malignancies among patients presenting with various symptoms, where a malignancy may be a differential diagnosis. Design - Survey of computerised journals. Diagnostic codes (ICD-9 system in primary health care) relating to signs, symptoms or diagnosis were selected where colorectal, pulmonary, breast and prostate malignancies might be differential diagnoses. All diagnostic actions were analysed. Subjects - 6812 patients over 30 years of age from four health centres who were recorded for a total of 14 455 selected diagnostic codes. Results - The diagnostic actions resulted in 1426 X-ray or sonographic investigations, 340 endoscopies, 16 203 haematology, clinical chemistry or microbiology tests and 667 referrals to specialists. Forty-nine malignancies were diagnosed at the primary health care centres, while 10 malignancies were classified as "missed". The frequency of faecal-occult blood tests performed was low while that of ESR and pulmonary X-ray examinations was high. Conclusion - The task for a GP identifying one or two undiagnosed malignancies per year of the four most common types among all the non-neoplastic ailments, and with as little diagnostic activity as possible, is a professional challenge to be scrutinised continuously.     

Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review

Peiris CL, Taylor NF, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review.

Objectives

To investigate whether extra physical therapy intervention reduces length of stay and improves patient outcomes in people with acute or subacute conditions.

Data Sources

Electronic databases CINAHL, MEDLINE, AMED, PEDro, PubMed, and EMBASE were searched from the earliest date possible through May 2010. Additional trials were identified by scanning reference lists and citation tracking.

Study Selection

Randomized controlled trials evaluating the effect of extra physical therapy on patient outcomes were included for review. Two reviewers independently applied the inclusion and exclusion criteria, and any disagreements were discussed until consensus could be reached. Searching identified 2826 potentially relevant articles, of which 16 randomized controlled trials with 1699 participants met inclusion criteria.

Data Extraction

Data were extracted using a predefined data extraction form by 1 reviewer and checked for accuracy by another. Methodological quality of trials was assessed independently by 2 reviewers using the PEDro scale.

Data Synthesis

Pooled analyses with random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used in meta-analyses. When compared with standard physical therapy, extra physical therapy reduced length of stay (SMD=−.22; 95% CI, −.39 to −.05) (mean difference of 1d [95% CI, 0–1] in acute settings and mean difference of 4d [95% CI, 0–7] in rehabilitation settings) and improved mobility (SMD=.37; 95% CI, .05–.69), activity (SMD=.22; 95% CI, .07–.37), and quality of life (SMD=.48; 95% CI, .29–.68). There were no significant changes in self-care (SMD=.35; 95% CI, −.06–.77).

Conclusions

Extra physical therapy decreases length of stay and significantly improves mobility, activity, and quality of life. Future research could address the possible benefits of providing extra services from other allied health disciplines in addition to physical therapy.     

Factors Predicting Inpatient Rehabilitation Length of Stay of Acute Stroke Patients in Singapore

Tan WS, Heng BH, Chua KS, Chan KF. Factors predicting inpatient rehabilitation length of stay of acute stroke patients in Singapore.

Objective

To determine the predictors of hospital length of stay (LOS) of stroke patients at the point of admission.

Design

A retrospective cohort study.

Setting

An acute hospital rehabilitation center in Singapore.

Participants

Stroke patients (N=491) admitted between March 2005 and December 2006.

Interventions

None.

Main Outcome Measures

Rehabilitation LOS was calculated as the total number of rehabilitation days before discharge. We measured the functional status of patients by using the Functional Independence Measure (FIM).

Results

The median LOS was 29 days (mean = 30.8d). Independent clinical and sociodemographic characteristics found to significantly predict rehabilitation LOS were FIM motor score at admission, the presence of more than 3 comorbid conditions at admission, living with nonimmediate relatives before admission, and the hospital subsidy status of the patient. In particular, the admission FIM motor score explained 43% of the variation in LOS and decreased the LOS by approximately 1.1 days for each 1-point increase in score.

Conclusion

Patients' socioeconomic status and family structure was found to influence LOS and should be considered in allocating resources and determining treatment need. The extent of motor function of patients at admission is an important factor influencing rehabilitation LOS and is a useful tool for facilitating rehabilitation resource planning for stroke patients.     

癌症患者症状群管理研究进展

癌症患者受疾病及其治疗影响常常存在多种症状.Dodd等[1]就此现象提出了症状群的概念.即同时存在、彼此关联的3个及以上症状.且群内症状不需拥有相同的病原学机制.如疼痛由疾病本身引起,疲乏由疾病与治疗引起,睡眠不安由化疗或焦虑引起.与单独症状相比,症状群存在协同作用,将加重癌症患者的症状负担.     

前列腺癌术后尿失禁患者康复护理方案的构建及应用

目的 构建前列腺癌术后尿失禁患者康复护理方案并进行初步应用,为临床上开展前列腺癌术后尿失禁患者康复护理提供参考。方法 基于循证文献检索、半结构式访谈初步构建前列腺癌术后尿失禁患者康复护理方案。于2022年1月—3月,通过对15名专家进行2轮函询,形成前列腺癌术后尿失禁患者康复护理方案。采用便利抽样法,选取2022年5月—7月在上海市某三级甲等医院泌尿外科门诊就诊的前列腺癌术后尿失禁患者作为研究对象。试验组采用前列腺癌术后尿失禁患者康复护理方案进行护理,对照组进行常规护理,使用国际尿失禁咨询委员会尿失禁问卷简表和24 h尿垫试验评价方案的初步应用效果。结果 形成的前列腺癌术后尿失禁患者康复护理方案包括6个一级条目、15个二级条目、43个三级条目;2轮函询的专家权威系数分别为0.88、0.98,肯德尔和谐系数分别为0.17、0.12（均P<0.001）;试验组术后1个月和术后3个月的国际尿失禁咨询委员会尿失禁问卷简表得分和24 h漏尿量均低于对照组（均P<0.05）。结论 该研究构建的前列腺癌术后尿失禁患者康复护理方案具有一定的科学性,应用该方案对前列腺癌术后患者进行指导可改善患者术后尿失禁的恢复情况,减少患者术后1个月和术后3个月的24 h漏尿量。     

癌症康复俱乐部护理运行模式的研究

目的:探讨癌症康复俱乐部的护理进行模式.方法:将癌症康复者250例建立个人和家庭健康档案,并按护理程序进行护理及指导,采用生存质量测定量表及焦虑自评量表,进行生活质量及焦虑程度的比较.结果:运用护理程序前后癌症康复者生活质量改善和不良反应情况比较,差异有统计学意义(P﹤0.05);运用护理程序前后癌症康复者焦虑程度比较,差异有统计学意义(P﹤0.05).结论:癌症康复俱乐部对癌症康复者进行评估、计划、实施和评价,促进了康复者心理、生理、精神及功能的康复,提高了生活质量.     

Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study

Meeus M, van Eupen I, van Baarle E, De Boeck V, Luyckx A, Kos D, Nijs J. Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study.

Objectives

To compare the activity pattern of patients with chronic fatigue syndrome (CFS) with healthy sedentary subjects and examine the relationship between the different parameters of performed activity (registered by an accelerometer device) and symptom severity and fluctuation (registered by questionnaires) in patients with CFS.

Design

Case-control study. Participants were asked to wear an accelerometer device on the nondominant hand for 6 consecutive days. Every morning, afternoon, and evening patients scored the intensity of their pain, fatigue, and concentration difficulties on a visual analog scale.

Setting

Patients were recruited from a specialized chronic fatigue clinic in the university hospital, where all subjects were invited for 2 appointments (for questionnaire and accelerometer adjustments). In between, activity data were collected in the subject's normal home environment.

Participants

Female patients (n=67) with CFS and female age-matched healthy sedentary controls.

Interventions

Not applicable.

Main Outcome Measures

Accelerometry (average activity counts, peak activity counts, ratio peak/average, minutes spent per activity category) and symptom severity (intensity of pain, fatigue, and concentration difficulties).

Results

Patients with CFS were less active, spent more time sedentary, and less time lightly active (P<.05). The course of the activity level during the registration period (P interaction>.05), peak activity, and the staggering of activities (ratio peak/average) on 1 day were not different between groups (P>.05). Negative correlations (–.242 varying to –.307) were observed for sedentary activity and the ratio with symptom severity and variation on the same and the next day. Light, moderate, and vigorous, as well as the average activity and the peak activity, were positively correlated (.242 varying to .421) with symptom severity and variation.

Conclusions

The more patients with CFS are sedentary and the better activity is dispersed, the fewer symptoms and variations they experience on the same and next day. Inversely, more symptoms and variability is experienced when patients were more active that day or the previous day. The direction of these relations cannot be determined in a cross-sectional study and requires further study.     

Nutritional status of cancer patients and its relationship to function in an inpatient rehabilitation setting

Background Malnutrition is associated with prolonged hospitalization, lower survival rate, and various medical complications. However, little is known about malnutrition and its relationship with the functional status. We undertook this retrospective study to examine whether or not malnutrition affects rehabilitation outcome in patients who had undergone cancer rehabilitation.Methods We conducted a review of the charts of 30 consecutive cancer patients who had been admitted to the inpatient rehabilitation unit in a tertiary cancer center, from the beginning of March 2001 to the end of April 2001.Results The patients mean rehabilitation stay was 9 days and their mean age was 58 years (range 22–86 years). On rehabilitation admission, 15 of the patients (50%) had a below normal prealbumin (<18 mg/dl) level (95% confidence interval 31–69%), and on discharge 10 of the patients (33%) had a below normal prealbumin level (95% CI 17–54%). The serum prealbumin concentration level correlated with motor functional independence measure scores on admission. After inpatient rehabilitation, statistically significant gains in functional independence measure scores (P<0.0001) were obtained in patients with below normal admission prealbumin, as well as in those whose prealbumin levels were within the normal range; no statistically significant difference was found in functional gain between these two groups.Conclusion Our study showed that a large number of cancer rehabilitation patients had malnutrition. Nevertheless, functional gain was achieved in all patients after rehabilitation, whether or not malnutrition was present. We conclude that malnourished patients should still be considered candidates for rehabilitation.     

Integrated assessment tool for daily activity and symptoms: A useful method to assess terminal cancer patients

Objectives: Given the necessity for proxy ratings at end of life, we developed the integrated assessment tool for daily activity and symptoms (IDAS) to evaluate patients with advanced cancer. This study aimed to define IDAS and to test its clinical utility by applying it for a large number of patients.

Methods: IDAS is defined as sum of positive aspects (e.g. eating) and negative aspects (e.g. pain) of patient’s life. IDAS is scored daily by nurses and is sequentially plotted in a graph that shows a longitudinal change of patient’s condition throughout hospitalization. We applied IDAS for 1924 patients in palliative care unit, categorizing them into short (<7 days), medium (7–31 days) and long (>32 days) term groups according to the length of hospitalization, and 4 subgroups according to IDAS subtypes defined by the average IDAS and positive/negative IDAS scores (type I: Well-controlled, type II: Fairly controlled, type III: Unstable, type IV: Impaired). IDAS scores were compared among short, medium and long-term groups by using analysis of variance (ANOVA). Length of hospitalization was compared among four subgroups according to IDAS subtypes by using ANOVA. The simple and multiple linear regression analysis was used to determine the association between average IDAS scores and length of hospitalization.

Results: Average IDAS and positive IDAS scores were the highest in long-term group (3.7 and 3.8), followed by medium-term (2.3 and 2.5) and short-term groups (0.6 and 0.9), whereas negative IDAS scores were highest in long-term group (?0.1), followed by medium-term (?0.2) and short-term (?0.3). Length of hospitalization was significantly different, with the mean for type I (50.1 days), type II (23.7), type III (23.0), and type IV (10.1). The correlation analysis showed a positive correlation between average IDAS scores and length of hospitalization.

Conclusions: Our results suggest that IDAS is a clinically feasible tool to daily evaluate both positive and negative aspects of patient’s condition throughout hospitalization. Higher average IDAS score was associated with a longer hospital stay, suggesting that certain time may be necessary to optimize palliative care treatment and control symptoms while disease severity upon admission may affect the duration of hospitalization.