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
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References
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Article Info
Publication History
Published online: June 02, 2017
Footnotes
Supported by the National Institutes of Health (grant nos. R01 HD069443, P30-AG024832, and 5K12HD055929-09); the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90AR5009), and the Agency for Healthcare Research and Quality (grant no. R24 HS022134).
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
