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Mangone E, Shahriary E, Bosch P. Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke. PM R 2024. [PMID: 39319640 DOI: 10.1002/pmrj.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF. OBJECTIVES Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke. DESIGN Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019. SETTING Academic hospital-based IRF. PARTICIPANTS Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hours of IRF admission. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Admission IRF-PAI self-care and mobility scores and discharge status from IRF. RESULTS Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF. CONCLUSIONS IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.
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Affiliation(s)
- Elizabeth Mangone
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Eashan Shahriary
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Pamela Bosch
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Department of Physical Therapy and Athletic Training, College of Health and Human Services, Northern Arizona University, Phoenix Bioscience Core, Phoenix, Arizona, USA
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Andrews AW, Bohannon RW. Improvements and Residual Limitations Experienced by Patients With Guillain-Barré Syndrome Undergoing Inpatient Rehabilitation. Am J Phys Med Rehabil 2023; 102:541-544. [PMID: 36897800 DOI: 10.1097/phm.0000000000002230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
ABSTRACT The purposes of this study were to (1) describe the level of functional independence of patients with Guillain-Barré syndrome before and after inpatient rehabilitation, (2) determine whether the level of functional independence increased in each functional domain during inpatient rehabilitation, and (3) determine whether independence at the end of inpatient rehabilitation differed significantly between domains. Data from patients with Guillain-Barré syndrome discharged from inpatient rehabilitation settings in 2019 were obtained from the Uniform Data System for Medical Rehabilitation database. The primary variables analyzed were paired, dichotomous variables of the number of patients who achieved full independence in the admission and discharge scores for the activities that comprise the domains, subscales, and total of the Functional Independence Measure. All patients admitted to inpatient rehabilitation required assistance with at least one if not several domains of function, motor, as well as cognitive. By the end of the inpatient rehabilitation stay, for each domain of function, significantly more patients were independent ( P < 0.0001). Independence at the end of inpatient rehabilitation differed significantly between domains ( P < 0.0001); more patients achieved independence in the communication (87.5%) and social cognition (74.8%) domains while fewer patients achieved independence in the self-care (35.9%), transfers (34.2%), and locomotion domains (24.7%).
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Affiliation(s)
- Addison Williams Andrews
- From the Department of Physical Therapy Education, Elon University, Elon, North Carolina (AWA); and Physical Therapy Consultants, Fuquay-Varina, North Carolina (RWB)
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Adam MD, Ness DK, Hollman JH. Physical Therapy Provider Continuity Predicts Functional Improvements in Inpatient Rehabilitation. J Neurol Phys Ther 2023; 47:91-98. [PMID: 36279402 DOI: 10.1097/npt.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Health care continuity has been linked to improved patient outcomes in a variety of professions and settings. Patients in inpatient rehabilitation receive a consistent dosage of physical therapy (PT) treatment; however, the providing physical therapist may vary. Despite the potential influence of PT provider continuity on functional outcomes in the inpatient rehabilitation setting, this association has not yet been studied. METHODS An observational retrospective chart review was conducted on 555 discharged inpatient rehabilitation patients. The relationship between the number of PT providers from whom a patient received care and Quality Indicator (QI) Mobility discharge scores was examined with Pearson product-moment correlation coefficients, initially with the entire patient group and secondarily with distinct diagnostic groups. Data from subgroups for whom a significant relationship was established were then included in a hierarchical linear regression analysis accounting for relevant covariates. RESULTS The number of PT providers correlated negatively with QI Mobility discharge scores ( r = -0.41, P ≤ 0.001). When controlling for QI Mobility admission scores, the "Stroke" (partial r = -0.17, P = 0.02), "Spinal Cord Injury" (partial r = -0.28, P = 0.002), and "Other Neuromuscular" (partial r = -0.35, P = 0.03) groups demonstrated significant inverse relationships. A hierarchical linear regression incorporating these 3 diagnostic groups revealed that the number of PT providers remained a significant predictor of QI Mobility discharge scores ( B = -1.50, P ≤ 0.001) when accounting for covariates. DISCUSSION AND CONCLUSIONS PT provider continuity is related to the functional improvement of neurologically impaired patients in inpatient rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A405 , which discusses the findings of this work in a narrative format).
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Affiliation(s)
- Mitchell D Adam
- Department of Physical Medicine and Rehabilitation (M.D.A), Mayo Clinic Hospital, Saint Mary's Campus, Rochester, Minnesota; and Mayo Clinic Neurologic Physical Therapy Residency Program (D.K.N) and Program in Physical Therapy in the Mayo Clinic School of Health Sciences (J.H.H.), Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Toth M, Palmer L, Marino ME, Smith A, Schwartz C, Deutsch A, McMullen T. Validation of the Standardized Function Data Elements among Medicare Skilled Nursing Facility Residents. J Am Med Dir Assoc 2023; 24:307-313.e1. [PMID: 36632833 DOI: 10.1016/j.jamda.2022.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge. DESIGN Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge. SETTING AND PARTICIPANTS Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs. METHODS We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity. RESULTS Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements. CONCLUSIONS AND IMPLICATIONS Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents.
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Affiliation(s)
- Matt Toth
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Research Triangle Park, NC, USA.
| | - Lauren Palmer
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | | | - Alice Smith
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | - Carole Schwartz
- Quality Measurement and Health Policy Program, RTI International, Chicago, IL, USA; RUSH University Medical Center, Chicago, IL, USA
| | - Anne Deutsch
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tara McMullen
- Opioid Safety, Pain Management, Opioid Safety, Prescription Drug Monitoring Program (PMOP), US Department of Veterans Affairs, Washington, DC, USA
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Downer B, Malagaris I, Li CY, Lee MJ, Deer R. The Influence of Prior Functional Status on Self-Care Improvement During a Skilled Nursing Facility Stay. J Am Med Dir Assoc 2022; 23:1861-1867. [PMID: 35395217 PMCID: PMC9532463 DOI: 10.1016/j.jamda.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Older adults' prior health status can influence their recovery after a major illness. We investigated the association between older adults' independence in self-care tasks prior to a skilled nursing facility (SNF) stay and their self-care function at SNF admission, discharge, and the change in self-care function during an SNF stay. DESIGN Retrospective study of 100% national CMS data files from October 1, 2018, to December 31, 2019. SETTINGS AND PARTICIPANTS The sample included 616,073 Medicare fee-for-service beneficiaries who were discharged from an SNF between October 1, 2018, and December 31, 2019. METHODS The admission Minimum Data Set (MDS) was used to determine residents' prior ability (independent, some help, dependent) to complete self-care tasks before the current illness, exacerbation, or injury. Seven self-care tasks from MDS Section GG were used to calculate total scores (range 7-42 points) for self-care at admission, discharge, and the change in self-care between admission and discharge. RESULTS Most residents (62.0%) were independent, 35.3% needed some help, and 2.64% were dependent in self-care prior to SNF admission. Nearly 25% of residents with urinary incontinence, 28.8% with bowel incontinence, and 31.7% with moderate-severe cognitive impairment were independent in self-care prior to SNF admission compared with approximately 70% of residents without these conditions. Compared with residents who were dependent in self-care prior to SNF admission, those who were independent or needed some help had significantly higher self-care total scores at admission (5.67 vs 4.21 points, respectively) and discharge (6.44 vs 3.82 points, respectively) and exhibited greater improvement in self-care (3.48 vs 1.62 points, respectively). CONCLUSIONS AND IMPLICATIONS Our findings are evidence that the new MDS item for a resident's independence in self-care tasks before SNF admission is a valid measure of their prior self-care function. This is clinically useful information and should be considered when developing rehabilitation goals.
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Affiliation(s)
- Brian Downer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
| | - Ioannis Malagaris
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Chih-Ying Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Mi Jung Lee
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Rachel Deer
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Vaughan M, McMullen T, Palmer L, Kwon S, Ingber MJ. The Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model. Arch Phys Med Rehabil 2022; 103:1096-1104. [DOI: 10.1016/j.apmr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
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Deutsch A, McMullen T, Vaughan M, Palmer L, Kwon S, Ingber MJ. The Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model. Arch Phys Med Rehabil 2022; 103:1085-1095. [DOI: 10.1016/j.apmr.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
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Deutsch A, Palmer L, Vaughan M, Schwartz C, McMullen T. Inpatient Rehabilitation Facility Patients’ Functional Abilities and Validity Evaluation of the Standardized Self-Care and Mobility Data Elements. Arch Phys Med Rehabil 2022; 103:1070-1084.e3. [DOI: 10.1016/j.apmr.2022.01.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/02/2022]
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Huang D, Siddiqui S, Slocum CS, Goldstein R, Zafonte RD, Schneider JC. Assessing the Ability of Comorbidity Indexes to Capture Comorbid Disease in the Inpatient Rehabilitation Spinal Cord Injury Population. Arch Phys Med Rehabil 2020; 101:1731-1738. [PMID: 32473110 DOI: 10.1016/j.apmr.2020.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine whether commonly used comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, the Centers for Medicare and Medicaid Services [CMS] comorbidity tiers) capture comorbidities in the acute traumatic and nontraumatic SCI inpatient rehabilitation population. DESIGN Retrospective cross-sectional study. PARTICIPANTS Data were obtained from the Uniform Data System for Medical Rehabilitation from October 1, 2015 to December 31, 2017 for adults with spinal cord injury (SCI) (Medicare-established Impairment Group Codes 04.110-04.230, 14.1, 14.3). This study included SCI discharges (N=66,235) from 833 inpatient rehabilitation facilities. MAIN OUTCOME MEASURES International Classification of Diseases-10th Revision-Clinical Modifications (ICD-10-CM) codes were used to assess 3 comorbidity indexes (Deyo-Charlson comorbidity index, Elixhauser comorbidity index, CMS comorbidity tiers). The comorbidity codes that occurred with >1% frequency were reported. The percentages of discharges for which no comorbidities were captured by each comorbidity index were calculated. RESULTS Of the total study population, 39,285 (59.3%) were men and 11,476 (17.3%) were tetraplegic. The mean number of comorbidities was 14.7. There were 13,939 distinct ICD-10-CM comorbidity codes. There were 237 comorbidities that occurred with >1% frequency. The Deyo-Charlson comorbidity index, Elixhauser comorbidity index, and the CMS tiers did not capture comorbidities of 58.4% (95% confidence interval, 58.08%-58.84%), 29.4% (29.07%-29.76%), and 66.1% (65.73%-66.46%) of the discharges in our study, respectively, and 28.8% (28.42%-29.11%) of the discharges did not have any comorbidities captured by any of the comorbidity indexes. CONCLUSION Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the SCI rehabilitation population. This work suggests that alternative measures may be needed to capture the complexity of this population.
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Affiliation(s)
- Donna Huang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Spinal Cord Injury Service, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA; Harvard Medical School, Boston, MA.
| | - Sameer Siddiqui
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Spinal Cord Injury Service, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, MA; Harvard Medical School, Boston, MA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Butzer JF, Kozlowski AJ, Virva R. Measuring Value in Postacute Care. Arch Phys Med Rehabil 2019; 100:990-994. [DOI: 10.1016/j.apmr.2018.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/14/2022]
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Li Y, Zhu Y, Chen C, Wang X, Choi Y, Henriksen C, Winterstein AG. Internal validation of Medicaid Analytic eXtract (MAX) data capture for comprehensive managed care plan enrollees from 2007 to 2010. Pharmacoepidemiol Drug Saf 2017; 27:1067-1076. [DOI: 10.1002/pds.4365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yan Li
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Yanmin Zhu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Chao Chen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Yoonyoung Choi
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy; University of Florida; Gainesville FL USA
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine; University of Florida; Gainesville FL USA
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Pardasaney PK, Deutsch A, Iriondo-Perez J, Ingber MJ, McMullen T. Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure. Arch Phys Med Rehabil 2017; 99:1035-1041. [PMID: 28363701 DOI: 10.1016/j.apmr.2017.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016. DESIGN Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability. SETTING IRFs. PARTICIPANTS Medicare FFS patients aged ≥21 years (N=4769). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Facility-level discharge self-care quality measure performance score. RESULTS A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%-100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91. CONCLUSIONS The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs.
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Affiliation(s)
| | - Anne Deutsch
- RTI International, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Tara McMullen
- Centers for Medicare & Medicaid Services, Baltimore, MD
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