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Inpatient Rehabilitation Facility Patients’ Functional Abilities and Validity Testing of the Standardized Self-Care and Mobility Data Elements

Published:February 11, 2022DOI:https://doi.org/10.1016/j.apmr.2022.01.147

      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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