Advertisement
Original research| Volume 99, ISSUE 6, P1067-1076, June 2018

Download started.

Ok

Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries

      Abstract

      Objectives

      To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.

      Design

      Retrospective cohort study.

      Setting

      Inpatient rehabilitation facilities submitting claims to Medicare.

      Participants

      National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1±7.6 years. Most were women (59.7%) and white (84.5%).

      Interventions

      Not applicable.

      Main Outcome Measures

      (1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions.

      Results

      The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3–3.5) versus 6.9% (95% CI, 6.7–7.1), mobility: 3.3% (95% CI, 3.2–3.4) versus 7.2% (95% CI, 7.0–7.4), and cognition: 3.5% (95% CI, 3.4–3.6) versus 6.2% (95% CI, 6.0–6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67–.74), mobility: .64 (95% CI, .61–.68), and cognition: .84 (95% CI, .80–.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).

      Conclusions

      Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.

      Keywords

      List of abbreviations:

      CI (confidence interval), CMS (Centers for Medicare and Medicaid Services), IMPACT Act (Improving Medicare Post-acute Care Transformation Act of 2014), IRF-PAI (Inpatient Rehabilitation Facility-Patient Assessment Instrument), MedPAR (Medicare Provider Analysis and Review)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. H.R. 4994 – 113th Congress: IMPACT Act of 2014.
        (Available at:) (Accessed September 1, 2016)
        • Department of Health and Human Services
        Federal Register. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2017; Final Rule.
        (Available at:) (Accessed November 18, 2016)
        • RTI International
        Measure Specifications for Measures Adopted in the FY 2017 IRF QRP Final Rule.
        (Available at:) (Accessed April 12, 2017)
        • Das A.
        • Norton E.C.
        • Miller D.C.
        • Chen L.M.
        Association of postdischarge spending and performance on new episode-based spending measure.
        JAMA Intern Med. 2016; 176: 117-119
        • Tsai T.C.
        • Greaves F.
        • Zheng J.
        • Orav E.J.
        • Zinner M.J.
        • Jha A.K.
        Better patient care at high-quality hospitals may save medicare money and bolster episode-based payment models.
        Health Aff (Millwood). 2016; 35: 1681-1689
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare and the Health Care Delivery System.
        (Available at:) (Accessed July 3, 2017)
        • Medicare Payment Advisory Commission
        March 2017 Report to the Congress: Medicare Payment Policy.
        (Available at:) (Accessed April 11, 2017)
        • Middleton A.
        • Graham J.E.
        • Lin Y.L.
        • et al.
        Motor and cognitive functional status are associated with 30-day unplanned rehospitalization following post-acute care in Medicare fee-for-service beneficiaries.
        J Gen Intern Med. 2016; 31: 1427-1434
        • Centers for Medicare & Medicaid Services
        The Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) training manual.
        (Available at:) (Accessed June 16, 2016)
        • Centers for Medicare & Medicaid Services
        Medicare Provider Analysis and Review (MEDPAR) File.
        (Available at:) (Accessed May 17, 2016)
      2. ResDAC. Master Beneficiary Summary File.
        (Available at:) (Accessed May 17, 2016)
        • Stineman M.G.
        • Ross R.N.
        • Fiedler R.
        • Granger C.V.
        • Maislin G.
        Functional independence staging: conceptual foundation, face validity, and empirical derivation.
        Arch Phys Med Rehabil. 2003; 84: 29-37
        • Agency for Healthcare Research and Quality
        Healthcare Cost and Utilization Project (HCUP). Clinical Classifications Software (CCS) 2015.
        (Available at:) (Accessed May 16, 2016)
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Fisher S.R.
        • Graham J.E.
        • Krishnan S.
        • Ottenbacher K.J.
        Predictors of 30-day readmission following inpatient rehabilitation for patients at high risk for hospital readmission.
        Phys Ther. 2016; 96: 62-70
        • Ottenbacher K.J.
        • Karmarkar A.
        • Graham J.E.
        • et al.
        Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
        JAMA. 2014; 311: 604-614
        • Galloway R.V.
        • Karmarkar A.M.
        • Graham J.E.
        • et al.
        Hospital readmission following discharge from inpatient rehabilitation for older adults with debility.
        Phys Ther. 2016; 96: 241-251
        • Burwell S.M.
        Setting value-based payment goals–HHS efforts to improve U.S. health care.
        N Engl J Med. 2015; 372: 897-899
        • Centers for Medicare & Medicaid Services
        List of Measures under Consideration for December 1, 2016.
        (Available at:) (Accessed February 3, 2017)
        • Berwick D.M.
        • Nolan T.W.
        • Whittington J.
        The triple aim: care, health, and cost.
        Health Aff (Millwood). 2008; 27: 759-769
        • van Walraven C.
        • Austin P.
        Administrative database research has unique characteristics that can risk biased results.
        J Clin Epidemiol. 2012; 65: 126-131