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Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure

Published:March 28, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.023

      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.

      Keywords

      List of abbreviations:

      CARE (Continuity Assessment Record and Evaluation), CI (confidence interval), CMS (Centers for Medicare & Medicaid Services), FFS (fee for service), ICC (intraclass correlation coefficient), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility–Patient Assessment Instrument), QRP (Quality Reporting Program)
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