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Inpatient Rehabilitation Facility Change in Self-Care and Change in Mobility Quality Measures: Development and Reliability and Validity Testing

  • Anne Deutsch
    Correspondence
    Corresponding author Anne Deutsch, PhD, RN, CRRN, RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA 02452-8413.
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Waltham, Massachusetts

    Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois

    Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Lauren Palmer
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Waltham, Massachusetts
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  • Molly Vaughan
    Affiliations
    Health Advance, RTI International, Waltham, Massachusetts
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  • Author Footnotes
    ⁎ Current affiliation for Tara McMullen: Veteran's Affairs, Baltimore, Maryland.
    Tara McMullen
    Footnotes
    ⁎ Current affiliation for Tara McMullen: Veteran's Affairs, Baltimore, Maryland.
    Affiliations
    Division of Post-Acute Care, Center for Clinical Standards and Quality (CCSQ), Centers for Medicare and Medicaid Services, Baltimore, Maryland
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  • Author Footnotes
    † Current affiliation for Amol Karmarkar: Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia and Sheltering Arms Institute, Richmond, Virginia.
    Amol Karmarkar
    Footnotes
    † Current affiliation for Amol Karmarkar: Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia and Sheltering Arms Institute, Richmond, Virginia.
    Affiliations
    RTI International, Waltham, Massachusetts
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  • Sophia Kwon
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Waltham, Massachusetts
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  • Melvin J. Ingber
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Waltham, Massachusetts
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  • Author Footnotes
    ⁎ Current affiliation for Tara McMullen: Veteran's Affairs, Baltimore, Maryland.
    † Current affiliation for Amol Karmarkar: Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia and Sheltering Arms Institute, Richmond, Virginia.
Published:February 07, 2022DOI:https://doi.org/10.1016/j.apmr.2021.12.031

      Abstract

      Objective

      To describe the development, implementation and reliability and validity testing of the inpatient rehabilitation facility (IRF) Change in Self-Care and Change in Mobility quality measures.

      Design

      We describe the activities involved in developing and implementing the 2 facility-level quality measures, including public comment opportunities. We examined facility-level reliability using split-half testing and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC2,1). We examined validity by comparing facility-level quality measure scores and facility disease-specific certification status.

      Setting

      All 1117 IRFs in the United States with at least 20 Medicare stays that ended in 2017.

      Participants

      Facility-level quality measure scores (N=1117) were derived from data from 427,517 (self-care) and 427,956 (mobility) Medicare fee-for-service and Medicare Advantage IRF patient stays in 2017.

      Interventions

      Not applicable.

      Main Outcome Measures

      Facility-level Change in Self-Care and Change in Mobility quality measure scores and facility Disease-Specific Certification for Stroke Rehabilitation from The Joint Commission were used in validity analysis.

      Results

      The split-half quality measure scores showed strong, positive correlations for the facility-level self-care (Pearson=0.903, Spearman=0.884, ICC=0.903, P<.0001) and mobility (Pearson=0.903, Spearman=0.884, ICC= 0.903, P<.0001) quality measure scores, providing evidence of reliability. ICCs remained strong when stratifying by provider volume. IRFs with stroke certification had slightly higher mean and median quality measure scores than IRFs without certification, and IRFs with the higher quality measure scores tended to have a higher percentage of certified IRFs.

      Conclusions

      Our analyses support the reliability and validity of the Change in Self-Care and Change in Mobility quality measure scores in IRFs.

      Keywords

      List of abbreviations:

      CMS (Centers for Medicare and Medicaid Services), ICC (intraclass correlation coefficient), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument), NQF (National Quality Forum), SNF (skilled nursing facility)
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