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Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model

  • Anne Deutsch
    Correspondence
    Corresponding author Anne Deutsch, PhD, RN, CRRN, Comprehensive Health Innovation, Research and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Waltham, Massachusetts

    Shirley Ryan AbilityLab, Chicago, Illinois

    Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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  • Author Footnotes
    # Current affiliation for McMullen: Department of Veterans Affairs.
    Tara McMullen
    Footnotes
    # Current affiliation for McMullen: Department of Veterans Affairs.
    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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  • Molly Vaughan
    Affiliations
    Health Advance, RTI International, Waltham, Massachusetts, United States
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  • Lauren Palmer
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Waltham, Massachusetts
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  • Sophia Kwon
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Waltham, Massachusetts
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  • Melvin J. Ingber
    Affiliations
    Comprehensive Health Innovation, Research, and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Waltham, Massachusetts
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  • Author Footnotes
    # Current affiliation for McMullen: Department of Veterans Affairs.
Published:March 08, 2022DOI:https://doi.org/10.1016/j.apmr.2022.02.009

      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)
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      References

        • O'Brien SR
        • Xue Y
        • Ingersoll G
        • Kelly A.
        Shorter length of stay is associated with worse functional outcomes for medicare beneficiaries with stroke.
        Phys Ther. 2013; 93: 1592-1602
        • Reistetter TA
        • Karmarkar AM
        • Graham JE
        • et al.
        Regional variation in stroke rehabilitation outcomes.
        Arch Phys Med Rehabil. 2014; 95: 29-38
        • Sandhu S
        • Furniss J
        • Metzler C.
        Using the new postacute care quality measures to demonstrate the value of occupational therapy.
        Am J Occup Ther. 2018; 72 (7202090010p7202090011-6)
        • Berlowitz DR
        • Stineman M.
        Risk adjustment in rehabilitation quality improvement.
        Top Stroke Rehabil. 2010; 17: 252-261
        • Chang EY
        • Chang E
        • Cragg S
        • Cramer SC.
        Predictors of gains during inpatient rehabilitation in patients with stroke: a review.
        Crit Rev Phys Rehabil Med. 2013; 25: 203-221
        • Corrigan JD
        • Horn SD
        • Barrett RS
        • et al.
        Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury.
        Arch Phys Med Rehabil. 2015; 96 (Suppl): S209-S221
        • Dubljanin-Raspopović E
        • Marković-Denić L
        • Matanović D
        • Grajić M
        • Krstić N
        • Bumbaširević M.
        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
        • Meyer MJ
        • Pereira S
        • McClure A
        • et al.
        A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation.
        Disabil Rehabil. 2015; 37: 1316-1323
        • Whyte E
        • Skidmore E
        • Aizenstein H
        • Ricker J
        • Butters M.
        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
        • Glance LG
        • Joynt Maddox K
        • Johnson K
        • et al.
        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
        • Iezzoni L.
        Risk Adjustment for measuring healthcare outcomes.
        Health Adminstration Press, Chicago, IL2012
        • Department of Health and Human Services
        Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2016.
        Fed Regist. 2015; 80: 47036-47139
      1. 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.

      2. 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.

        • Smith L
        • Deutsch A
        • Barch D
        • et al.
        Continuity Assessment Record and Evaluation (CARE) item set: video reliability testing.
        RTI International, Waltham, MA2012
        • Smith L
        • Deutsch A
        • Hand L
        • et al.
        Continuity Assessment Record and Evaluation (CARE) item set: additional provider-type specific interrater reliability analyses.
        RTI International, Waltham, MA2012
        • Colantuoni E
        • Scharfstein DO
        • Wang C
        • et al.
        Statistical methods to compare functional outcomes in randomized controlled trials with high mortality.
        BMJ. 2018; 360: j5748
        • Deutsch A
        • Pardasaney P
        • Iriondo-Perez J
        • Ingber MJ
        • Porter KA
        • McMullen T.
        Development of a risk-adjustment model for the inpatient rehabilitation facility discharge self-care functional status quality measure.
        Med Care. 2017; 55: 706-715
        • 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. 2021 Feb 7; ([Epub ahead of print])
        • Dallas MI
        • Rone-Adams S
        • Echternach JL
        • Brass LM
        • Bravata DM.
        Dependence in prestroke mobility predicts adverse outcomes among patients with acute ischemic stroke.
        Stroke. 2008; 39: 2298-2303
        • US Department of Health Human Services
        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
        • Committee on Accounting for Socioeconomic Status in Medicare Payment Programs; Board on Population Health and Public Health Practice; Board on Health Care Services; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine
        Accounting for social risk factors in Medicare payment.
        National Academies Press, Washington (DC)2017
        • Medicare Payment Advisory Commission
        Report to Congress: Medicare and the Health Care Delivery System.
        Medicare Payment Advisory Commission, Washington (DC)2019