Abstract
Objective
Design
Setting
Participants
Interventions
Main Outcome Measures
Results
Conclusion
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)Methods
Study Design and Data Source
Dependent Variables
Data Analyses
Results
Dependent Variables | Year | Mean Change | |||||
---|---|---|---|---|---|---|---|
1998 | 1999 | 2000 | 2001 | 2002 | 2003 | ||
Stroke | |||||||
Number of records | |||||||
Number of patient records | 30,682 | 30,617 | 29,840 | 28,800 | 30,284 | 30,531 | |
PI-adjusted total number of patient records | 31,555 | 31,459 | 30,705 | 29,591 | |||
Change with PI adjustment | 873 | 842 | 865 | 791 | 843 (2.81%) | ||
Community discharge | |||||||
% of patients discharged to the community | 71.49 | 71.66 | 72.11 | 71.93 | 69.04 | 67.82 | |
PI-adjusted % of patients discharged to the community | 69.51 | 69.74 | 70.08 | 70.01 | |||
Change with PI adjustment | −1.98 | −1.92 | −2.03 | −1.92 | −1.96 | ||
Acute care discharge | |||||||
% of patients discharged to acute care | 5.68 | 5.67 | 5.73 | 6.10 | 9.37 | 10.44 | |
PI-adjusted % of patients discharged to acute care | 8.29 | 8.20 | 8.39 | 8.61 | |||
Change with PI adjustment | 2.61 | 2.53 | 2.66 | 2.51 | 2.57 | ||
Program interruptions | |||||||
% of patients with program interruptions | 3.38 | 3.32 | 3.40 | 3.23 | 0.91 | 0.87 | |
PI-adjusted % with program interruptions | 0.70 | 0.72 | 0.65 | 0.63 | |||
Change with PI adjustment | −2.68 | −2.60 | −2.75 | −2.60 | −2.65 | ||
Inpatient deaths | |||||||
% of patients who died | 0.38 | 0.39 | 0.30 | 0.39 | 0.28 | 0.24 | |
PI-adjusted % who died | 0.37 | 0.38 | 0.30 | 0.38 | |||
Change with PI adjustment | −0.01 | −0.01 | −0.01 | −0.01 | −0.01 | ||
LOS | |||||||
LOS (d) | 19.16 | 18.72 | 18.22 | 17.84 | 16.68 | 16.36 | |
PI-adjusted LOS (d) | 18.63 | 18.22 | 17.71 | 17.36 | |||
Change with PI adjustment | −0.53 | −0.50 | −0.51 | −0.48 | −0.51 | ||
Traumatic SCI | |||||||
Number of records | |||||||
Total number of patient records | 764 | 757 | 798 | 843 | 1,071 | 995 | |
PI-adjusted total number of patient records | 809 | 798 | 847 | 889 | |||
Change with PI adjustment | 45 | 41 | 49 | 46 | 45 (5.16%) | ||
Community discharge | |||||||
% of patients discharged to the community | 71.07 | 72.13 | 71.68 | 69.75 | 66.20 | 64.02 | |
PI-adjusted % of patients discharged to the community | 67.12 | 68.42 | 67.53 | 66.14 | |||
Change with PI adjustment | −3.95 | −3.71 | −4.15 | −3.61 | −3.85 | ||
Acute care discharge | |||||||
% of patients discharged to acute care | 6.81 | 6.87 | 5.89 | 8.19 | 14.47 | 14.87 | |
PI-adjusted % of patients discharged to acute care | 11.99 | 11.65 | 11.33 | 12.94 | |||
Change with PI adjustment | 5.18 | 4.78 | 5.44 | 4.75 | 5.04 | ||
Program interruptions | |||||||
% of patients with program interruptions | 6.54 | 6.34 | 7.02 | 6.29 | 1.12 | 1.11 | |
PI-adjusted % with program interruptions | 1.24 | 1.50 | 2.01 | 0.90 | |||
Change with PI adjustment | −5.30 | −4.84 | −5.01 | −5.39 | −5.14 | ||
Inpatient deaths | |||||||
% of patients who died | 0.39 | 1.06 | 0.63 | 0.36 | 0.47 | 0.10 | |
PI-adjusted % who died | 0.37 | 1.00 | 0.59 | 0.34 | |||
Change with PI adjustment | −0.02 | −0.05 | −0.04 | −0.02 | −0.03 | ||
Traumatic SCI (cont'd) | |||||||
LOS | |||||||
LOS (d) | 23.57 | 22.96 | 24.77 | 22.59 | 19.51 | 18.22 | |
PI-adjusted LOS (d) | 22.24 | 21.78 | 23.37 | 21.42 | |||
Change with PI adjustment | −1.33 | −1.18 | −1.40 | −1.17 | −1.27 | ||
Replacement, lower extremity | |||||||
Number of records | |||||||
Total number of patient records | 26,743 | 28,073 | 31,920 | 36,019 | 41,793 | 44,833 | |
PI-adjusted total number of patient records | 27,032 | 28,380 | 32,237 | 36,353 | |||
Change with PI adjustment | 289 | 307 | 317 | 334 | 312 (0.89%) | ||
Community discharge | |||||||
% of patients discharged to the community | 92.27 | 92.55 | 93.05 | 93.33 | 92.90 | 92.94 | |
PI-adjusted % of patients discharged to the community | 91.28 | 91.55 | 92.14 | 92.47 | |||
Change with PI adjustment | −0.99 | −1.00 | −0.91 | −0.86 | −0.94 | ||
Acute care discharge | |||||||
% of patients discharged to acute care | 1.79 | 1.65 | 1.84 | 1.74 | 2.97 | 3.04 | |
PI-adjusted % of patients discharged to acute care | 2.84 | 2.71 | 2.80 | 2.65 | |||
Change with PI adjustment | 1.05 | 1.06 | 0.96 | 0.91 | 1.00 | ||
Program interruptions | |||||||
% of patients with program interruptions | 1.25 | 1.33 | 1.20 | 1.14 | 0.31 | 0.34 | |
PI-adjusted % with program interruptions | 0.21 | 0.27 | 0.26 | 0.25 | |||
Change with PI adjustment | −1.04 | −1.06 | −0.94 | −0.89 | −0.98 | ||
Inpatient deaths | |||||||
% of patients who died | 0.06 | 0.06 | 0.03 | 0.04 | 0.02 | 0.03 | |
PI-adjusted % who died | 0.06 | 0.06 | 0.03 | 0.04 | |||
Change with PI adjustment | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | ||
LOS | |||||||
LOS (d) | 10.17 | 9.91 | 9.70 | 9.34 | 8.66 | 8.49 | |
PI-adjusted LOS (d) | 10.06 | 9.80 | 9.60 | 9.25 | |||
Change with PI adjustment | −0.11 | −0.11 | −0.10 | −0.09 | 0.10 |
Discussion
Study Limitations
Conclusions
Acknowledgments
References
- Guide to the Uniform Data Set for Medical Rehabilitation (Version 5).State University of New York at Buffalo, Buffalo1997
- Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) training manual.Uniform Data System for Medical Rehabilitation, Buffalo2001
- 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
- Modifications to the FIM(TM) instrument under the inpatient rehabilitation prospective payment system.Am J Phys Med Rehabil. 2007; 86: 883-892
Article Info
Footnotes
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.