Abstract
Objective
To describe the abilities of Medicare patients in inpatient rehabilitation facilities
(IRFs) at admission and discharge using the standardized self-care and mobility data
elements and examine the validity of the data elements. These data are used in the
Center for Medicare & Medicaid's IRF payment and quality reporting programs.
Design
Descriptive study reporting IRF patients’ self-care and mobility scores. We also examined
content validity and the associations between admission scores and length of stay
(LOS), discharge scores and discharge destination, and change scores and the number
of comorbidities.
Setting
Patients discharged from 1129 IRFs in 2017.
Participants
IRF Medicare fee-for-service and Medicare Advantage patient stays (N = 493,209).
Interventions
Not applicable.
Main Outcome Measure(s)
Self-care and mobility item scores, IRF LOS, discharge destination, and categories
of the number of comorbidities.
Results
For each self-care and mobility activity, patients in IRFs overall made substantial
improvements in function between admission and discharge. For example, the percentage
of patients independent with eating and toilet transfers increased from 29.04% to
66.68% and 0.80% to 39.87%, respectively, between admission and discharge. Activities
represented in the standardized data elements are included in other functional assessment
instruments addressing content validity. Analyses showed a monotonic relationship
between admission scores and LOS and between discharge scores and discharge to community
percentages with only a few exceptions. Self-care and mobility scale change scores
decreased as the number of comorbidities increased across categories.
Conclusions
Patients in IRFs overall show functional improvement across each of the activities
as defined by the standardized self-care and mobility data elements. The results showing
the associations between patient functioning and 3 metrics (LOS, discharge to community
rates, and number of comorbidities) support the validity of the data elements measuring
functional abilities in the IRF Medicare population.
List of abbreviations:
CMS (Centers for Medicare & Medicaid Services), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment Instrument), ICF (International Classification of Functioning, Disability and Health), LOS (length of stay), PAC (post-acute care)Keywords
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References
- Functional evaluation: the Barthel Index: a simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill.Md State Med J. 1965;14:61-5;
- Improving the sensitivity of the Barthel Index for stroke rehabilitation.J Clin Epidemiol. 1989; 42: 703-709
- Stroke rehabilitation: analysis of repeated Barthel index measures.Arch Phys Med Rehabil. 1979; 60: 14-17
- Barthel index for stroke trials: development, properties, and application.Stroke. 2011; 42: 1146-1151
- The functional independence measure (FIMSM Instrument) and the functional independence measure for children (WeeFIM® Instrument): ten years of development.Crit Rev Phys Rehabil Med. 1996; 8: 267-281
- Interrater reliability of the 7-level functional independence measure (FIM).Scand J Rehabil Med. 1994; 26: 115-119
- The Uniform Data System for Medical Rehabilitation Report of Patients Discharged from Comprehensive Medical Rehabilitation Programs in 1999.Am J Phys Med Rehabil. 2002; 81: 133-142
- UDS report: the Uniform Data System for Medical Rehabilitation report of first admissions for 1990.Am J Phys Med Rehabil. 1992; 71: 108-113
- A case-mix classification system for medical rehabilitation.Med Care. 1994;32;366-79;
- Medicare program; prospective payment system for inpatient rehabilitation facilities; proposed rule.Fed Regist. 2000; 65: 66304-66442
- Modifications of the FIM instrument under the inpatient rehabilitation facility prospective payment system.Am J Phys Med Rehabil. 2007; 86: 883-892
The Patient Protection and Afforable Care Act of 2010, Public Law No. 111-148, 124, Stat. 119 through 1025 (2010).
- Characterizing rehabilitation services for patients with knee and hip replacement in skilled nursing facilities and inpatient rehabilitation facilities.Arch Phys Med Rehabil. 2009; 90: 1269-1283
- Poststroke rehabilitation: outcomes and reimbursement of inpatient rehabilitation facilities and subacute rehabilitation programs.Stroke. 2006; 37: 1477-1482
- Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.Arch Phys Med Rehabil. 2014; 95: 209-217
- Substitutability across institutional post-acute care settings: 1998-2006.Princeton: Mathematica Policy Research;. 2009;
Deficit Reduction Act of 2005, Public Law No: 109-171, Section 5008, 120 Stat 4. (2005).
- Perspectives on the state-of-the-science in rehabilitation medicine and its implications for Medicare postacute care policies.Arch Phys Med Rehabil. 2007; 88: 1737-1739
Gage B, Constantine R, Aggarwal J, et al. The development and testing of the Continuity Assessment Record and Evaluation (CARE) item set. Vol 1. Waltham: RTI International; 2012.
Gage B, Ingber M, Smith L, et al. Post-Acute Care Payment Reform Demonstration: final report. Vol 4. Waltham: RTI International; 2012.
Gage B, Smith L, Ross J, et al. The development and testing of the Continuity Assessment Record and Evaluation (CARE) item set: final report on reliability testing. Vol 2. Waltham: RTI International; 2012.
Improving Post-Acute Care tranformation (IMPACT) Act of 2014, Public Law No: 113-185, 128 Stat. 1952 (42 U.S.C. § 1395) (2014).
- Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2016.Fed Regist. 2015; 80: 47036-47139
- Analysis of crosscutting Medicare functional status quality metrics using the Continuity and Assessment Record and Evaluation (CARE) item set—final report.RTI International, Washington, DC2012
- Development of a risk-adjustment model for the inpatient rehabilitation facility Discharge Self-care Functional Status Quality Measure.Med Care. 2017; 55: 706-715
- Measuring inpatient rehabilitation facility quality of care: Discharge Self-care Functional Status Quality measure.Arch Phys Med Rehabil. 2018; 99: 1035-1041
- Medicare program; prospective payment system for inpatient rehabilitation facilities for federal fiscal year 2020 and updates to the IRF quality reporting program; final rule.Fed Regist. 2019; 84: 39054-39173
Deutsch A, Palmer L, Vaughan M, et al. The Inpatient Rehabilitation Facility Change in Self-Care and Change in Mobility Quality measures: development and reliability and validity testing. Arch Phys Med Rehabil; in press.
- RIC-FAS II: Rehabilitation Institute of Chicago Functional Assessment Scale.Chicago; Rehabilitation Institute of Chicago; 1989
- Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+ FAM, DRS, and CIQ.J Head Trauma Rehabil. 1996;11:27-39;
- Does the functional assessment measure (FAM) extend the functional independence measure (FIM) instrument? A rasch analysis of stroke inpatients.J Outcome Meas. 1999; 3: 339-359
- Stability of performance of activities of daily living using the MDS.Gerontologist. 2000; 40: 582-586
- A Rasch-validated version of the upper extremity functional index for interval-level measurement of upper extremity function.Phys Ther. 2013; 93: 1507-1519
- Progress in development of the index of ADL.Gerontologist. 1970; 10: 20-30
- Measurement properties of the lower extremity functional scale: a systematic review.J Orthop Sports Phys Ther. 2016; 46: 200-216
- Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice.Disabil Rehabil. 2002; 24: 281-282
Smith L, Deutsch A, Hand L, et al. Continuity Assessment Record and Evaluation (CARE) item set: additional provider-type specific interrater reliability analyses. Waltham: RTI International; 2012.
Article info
Publication history
Published online: February 11, 2022
Accepted:
January 12,
2022
Received in revised form:
January 11,
2022
Received:
November 4,
2021
Footnotes
Current affiliation for Carole Schwartz: RUSH University Medical Center, Chicago, IL.
Current affiliation for Tara McMullen: Veteran's Affairs, Baltimore, MD.
Supported by the Centers for Medicare & Medicaid Services (CMS) under contract HHSM-500-2013-13015I and RTI International.
Disclosure: The statements contained in the article are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information.
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© 2022 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
