Volume 89, Issue 12 , Pages 2274-2277, December 2008
Apparent Changes in Inpatient Rehabilitation Facility Outcomes Due to a Change in the Definition of Program Interruption
Abstract
Deutsch A, Granger CV, Russell C, Heinemann AW, Ottenbacher KJ. Apparent changes in inpatient rehabilitation facility outcomes due to a change in the definition of program interruption.
Objective
To describe changes in inpatient rehabilitation facility (IRF) outcomes due to the program interruption definitional change, from 30 days to 3 days, in 2002.
Design
Secondary data analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database.
Setting
Four hundred eleven IRFs that submitted data to the UDSMR database in each of the years 1998 through 2003.
Participants
Patient assessment data for 772,584 Medicare fee-for-service beneficiaries.
Interventions
None.
Main Outcome Measures
The number of IRF patient discharges, percent of IRF patients discharged to the community, percent of IRF patients discharged to acute care, percent of IRF patients with program interruptions, percent of IRF inpatient deaths, and average IRF length of stay (LOS).
Results
IRF outcomes appeared to change because of the program interruption redefinition, with changes varying by impairment group. The largest changes due to the redefinition occurred for patients with traumatic spinal cord injury, including the largest percentage increase in patients (5.16%), the largest decrease in program interruptions (5.14%), the largest increase in acute care discharges (5.04%), and the largest mean decrease in LOS (1.27d). Community discharge showed the largest decrease for patients with Guillain-Barré syndrome (4.03%).
Conclusion
The change in the definition of program interruptions creates the appearance of changes in IRF performance and is important to consider when comparing the preprospective payment system (PPS) and PPS assessment data.
Key Words: Outcomes, Prospective payment system, Rehabilitation
List of Abbreviations: IRF, inpatient rehabilitation facility, IRF-PAI, Inpatient Rehabilitation Facility Patient Assessment Instrument, LOS, length of stay, PPS, prospective payment system, SCI, spinal cord injury, UDSMR, Uniform Data System for Medical Rehabilitation
Supported by a Switzer Fellowship (award no. H133F040032) and Disability and Rehabilitation Research Program (grant no. H133A030807) from the National Institute on Disability and Rehabilitation Research.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
PII: S0003-9993(08)01486-X
doi:10.1016/j.apmr.2008.06.014
© 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 89, Issue 12 , Pages 2274-2277, December 2008
