Original research| Volume 99, ISSUE 8, P1514-1524.e1, August 2018

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Mandated Quality of Care Metrics for Medicare Patients: Examining New or Worsened Pressure Ulcers and Rehabilitation Outcomes in United States Inpatient Rehabilitation Facilities

Published:April 09, 2018DOI:



      To examine the association between the Medicare pressure ulcer quality indicator (the development of new or worsened pressure ulcers) and rehabilitation outcomes among Medicare patients seen in an inpatient rehabilitation facility (IRF).


      Retrospective descriptive study.


      IRFs subscribed to the Uniform Data System for Medical Rehabilitation.


      Nearly 500,000 IRF Medicare patients who were discharged between January 2013 and September 2014 were examined.


      Not applicable.

      Main Outcome Measures

      Functional independence, functional change (gain), and discharge destination.


      The pressure ulcer quality indicator was associated with poorer rehabilitation outcomes; patients were less likely to achieve functional independence (odds ratio [OR], .47; 95% confidence interval [CI], .44–.51), were less likely to be discharged to a community setting (OR, .88; 95% CI, .82–.95), and made less functional gain during their IRF stay (a difference of 6 FIM points).


      These results support that the pressure ulcer quality indicator is associated with lower quality of rehabilitation outcomes; however, given that those patients with a new or worsened pressure injury still made functional gains and most were discharged to the community, the risk of pressure injury development should not preclude the admission of these cases to an IRF.


      List of abbreviations:

      CI (confidence interval), CMS (Centers for Medicare and Medicaid Services), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument), NQF (National Quality Forum), UDSMR (Uniform Data System for Medical Rehabilitation)
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