Abstract
Objective
To examine facility-level rates of all-cause, unplanned hospital readmissions for
30 days after discharge from inpatient rehabilitation facilities (IRFs).
Design
Observational design.
Setting
Inpatient rehabilitation facilities.
Participants
Medicare fee-for-service beneficiaries (N=567,850 patient-stays).
Interventions
Not applicable.
Main Outcome Measures
The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted
previous risk-adjustment and statistical approaches used for acute care hospitals
to develop a hierarchical logistic regression model that estimates a risk-standardized
readmission rate for each IRF. The IRF risk-adjustment model takes into account patient
demographic characteristics, hospital diagnoses and procedure codes, function at IRF
admission, comorbidities, and prior hospital utilization. We presented national distributions
of observed and risk-standardized readmission rates and estimated confidence intervals
to make statistical comparisons relative to the national mean. We also analyzed the
number of days from IRF discharge until hospital readmission.
Results
The national observed hospital readmission rate by 30 days postdischarge from IRFs
was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean
risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment
model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were
significantly different from the mean. The mean number of days to readmission was
13.0±8.6 days and varied by rehabilitation diagnosis.
Conclusions
Our results demonstrate the ability to assess 30-day, all-cause hospital readmission
rates postdischarge from IRFs and the ability to discriminate between IRFs with higher-
and lower-than-average hospital readmission rates.
Keywords
List of abbreviations:
CMS (Centers for Medicare & Medicaid Services), FFS (fee-for-service), IRF (inpatient rehabilitation facility), MA (Medicare Advantage), PPS (prospective payment system), QRP (Quality Reporting Program), RSRR (risk-standardized readmission rate), SRR (standardized risk ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 09, 2017
Footnotes
Supported by the Centers for Medicare & Medicaid Services (contract no. HHSM-500-2013-13015I). The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
