Abstract
Objective
To describe the exclusion criteria and risk-adjustment model developed for the quality
measure Change in Self-Care. The exclusion criteria and risk adjustment model are
used to calculate Change in Self-Care scores, allowing scores to be compared across
inpatient rehabilitation facilities (IRFs).
Design
This national cohort study examined admission demographic and clinical factors associated
with IRF patients’ self-care change scores using standardized self-care data for Medicare
patients discharged in calendar year 2017.
Setting
A total of 1129 IRFs in the United States.
Participants
A total of 493,209 (N=493,209) Medicare Fee-for-Service and Medicare Advantage IRF
patient stays
Interventions
Not applicable.
Main Outcome Measures
Self-care change scores using admission and discharge standardized assessment data
elements from the Inpatient Rehabilitation Facility–Patient Assessment Instrument.
Results
Approximately 53% of patients were female, and 67% were between 65 and 84 years old.
The final risk-adjustment model contained 93 clinically relevant risk adjusters and
explained 23.1% of variance in self-care change scores. Risk adjusters that had the
greatest effect on change scores and included IRF primary diagnosis group (ie, binary
risk adjusters representing 13 diagnoses), prior self-care functioning, and age older
than 90 years. When split by deciles of expected scores, the ratio of the average
expected and observed change scores was within 2% of 1.0 across 8 groups and within
8% at the extremes, showing good predictive accuracy.
Conclusions
The risk adjustment model quantifies the relationship between IRF patients’ demographic
and clinical characteristics and their self-care score changes. The exclusion criteria
and model are used to risk-adjust the IRF Change in Self-Care quality measure.
Keywords
List of abbreviations:
BMI (body mass index), CMS (Centers for Medicare and Medicaid Services), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility–Patient Assessment Instrument)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Shorter length of stay is associated with worse functional outcomes for medicare beneficiaries with stroke.Phys Ther. 2013; 93: 1592-1602
- Regional variation in stroke rehabilitation outcomes.Arch Phys Med Rehabil. 2014; 95: 29-38
- Using the new postacute care quality measures to demonstrate the value of occupational therapy.Am J Occup Ther. 2018; 72 (7202090010p7202090011-6)
- Risk adjustment in rehabilitation quality improvement.Top Stroke Rehabil. 2010; 17: 252-261
- Predictors of gains during inpatient rehabilitation in patients with stroke: a review.Crit Rev Phys Rehabil Med. 2013; 25: 203-221
- Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury.Arch Phys Med Rehabil. 2015; 96 (Suppl): S209-S221
- Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?.Arch Med Sci. 2012; 8: 115
- A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation.Disabil Rehabil. 2015; 37: 1316-1323
- Cognitive impairment in acquired brain injury: a predictor of rehabilitation outcomes and an opportunity for novel interventions.PM R. 2011; 3 (Suppl 1): S45-S51
- National Quality Forum guidelines for evaluating the scientific acceptability of risk-adjusted clinical outcome measures: a report from the National Quality Forum Scientific Methods Panel.Ann Surg. 2020; 271: 1048-1055
- Risk Adjustment for measuring healthcare outcomes.Health Adminstration Press, Chicago, IL2012
- Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2016.Fed Regist. 2015; 80: 47036-47139
Gage B, Constantine R, Aggarwal J, et al. The development and testing of the Continuity Assessment Record and Evaluation (CARE) item set, volume 1 of 3. Waltham, MA: 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, volume 2 of 3. Waltham, MA: RTI International; 2012.
- Continuity Assessment Record and Evaluation (CARE) item set: video reliability testing.RTI International, Waltham, MA2012
- Continuity Assessment Record and Evaluation (CARE) item set: additional provider-type specific interrater reliability analyses.RTI International, Waltham, MA2012
- Statistical methods to compare functional outcomes in randomized controlled trials with high mortality.BMJ. 2018; 360: j5748
- Development of a risk-adjustment model for the inpatient rehabilitation facility discharge self-care functional status quality measure.Med Care. 2017; 55: 706-715
- The inpatient rehabilitation facility change in self-care and change in mobility quality measures: development and reliability and validity testing.Arch Phys Med Rehabil. 2021 Feb 7; ([Epub ahead of print])
- Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke.Stroke. 2008; 39: 2298-2303
- Report to Congress: social risk factors and performance under Medicare’s value-based purchasing programs. US Department of Health and Human Services, Washington (DC)2018
- Accounting for social risk factors in Medicare payment.National Academies Press, Washington (DC)2017
- Report to Congress: Medicare and the Health Care Delivery System.Medicare Payment Advisory Commission, Washington (DC)2019
Article info
Publication history
Published online: March 08, 2022
Accepted:
February 14,
2022
Received in revised form:
January 31,
2022
Received:
August 11,
2021
Footnotes
Supported by the Centers for Medicare and Medicaid Services (CMS) under contract HHSM-500-2013-13015I and RTI International.
The statements contained in the manuscript 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.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
