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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

      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)
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      References

      1. Guide to the Uniform Data Set for Medical Rehabilitation (Version 5).
        State University of New York at Buffalo, Buffalo1997
      2. Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) training manual.
        Uniform Data System for Medical Rehabilitation, Buffalo2001
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        • Russell C.F.
        The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999.
        Am J Phys Med Rehabil. 2002; 81: 133-142
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        • Ottenbacher K.J.
        Modifications to the FIM(TM) instrument under the inpatient rehabilitation prospective payment system.
        Am J Phys Med Rehabil. 2007; 86: 883-892