Advertisement
Archives of Physical Medicine and Rehabilitation
Advanced searchSave search
ORIGINAL RESEARCH| Volume 103, ISSUE 6, P1096-1104, June 2022

Download started.

Ok

Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model

Published:March 08, 2022DOI:https://doi.org/10.1016/j.apmr.2022.03.001
Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model
Previous ArticleChange in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model
Next ArticleInpatient Rehabilitation Facility Change in Self-Care and Change in Mobility Quality Measures: Development and Reliability and Validity Testing

      Abstract

      Objective

      To describe the exclusion criteria and updated risk adjustment model developed for the Change in Mobility quality measure in the inpatient rehabilitation facility (IRF) quality reporting program. Facility-level quality measures focused on patient outcomes usually require risk adjustment to account for varied admission characteristics of patients across facilities.

      Design

      This cohort study analyzed admission demographic and clinical factors associated with mobility change scores using the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data for Medicare patients discharged from IRFs 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 discharged in calendar year 2017.

      Interventions

      Not applicable.

      Main Outcome Measures

      Mobility change scores using admission and discharge standardized assessment data from the IRF-PAI.

      Results

      Approximately 53% of patients in the study were female, 67% were aged 65-84 years, and nearly 80% were White. In the final risk adjustment model, 105 covariates were included, explaining 20% of variance in mobility change scores. Key risk adjusters included IRF primary diagnosis group, prior indoor ambulation functioning, age older than 90 years, and 14 of the comorbidities. The model showed good calibration across the range of deciles of predicted IRF mobility change scores; the ratio of the average expected to observed change scores ranged from 0.93-1.03, with all but 1 within ±0.03.

      Conclusions

      The updated risk adjustment model uses IRF patients' demographic and clinical characteristics to predict their mobility change scores. The exclusion criteria and resulting risk model are used to calculate the risk adjusted Change in Mobility quality measure scores, enabling comparisons of Change in Mobility scores across IRFs.

      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 access
      One-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 Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      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
        View in Article
        • Reistetter TA
        • Karmarkar AM
        • Graham JE
        • et al.
        Regional variation in stroke rehabilitation outcomes.
        Arch Phys Med Rehabil. 2014; 95: 29-38
        View in Article
        • Berlowitz DR
        • Stineman M.
        Risk adjustment in rehabilitation quality improvement.
        Top Stroke Rehabil. 2010; 17: 252-261
        View in Article
        • 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
        View in Article
        • 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: S209-S221
        View in Article
        • 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
        View in Article
        • 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
        View in Article
        • 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: S45-S51
        View in Article

      9. Centers for Medicare and Medicaid Services. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP). Available at:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting. Accessed October 30, 2021.

        View in Article

      10. The Patient Protection and Afforable Care Act of 2010, Public Law No. 111-148, 124, Stat. 119 through 1025. 2010.

        View in Article
        • 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
        View in Article

      12. 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.

        View in Article

      13. 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.

        View in Article
        • Smith L
        • Deutsch A
        • Barch D
        • et al.
        Continuity Assessment Record and Evaluation (CARE) item set: video reliability testing.
        RTI International, Waltham, MA2012
        View in Article

      15. Smith L, Deutsch A, Hand L, et al., Continuity Assessment Record and Evaluation (CARE) item set: additional provider-type specific interrater reliability analyses. Waltham, MA: RTI International; 2012.

        View in Article
        • Gage B
        • Ingber M
        • Smith L
        • et al.
        Post-acute care payment reform demonstration: final report volume 4 of 4.
        RTI International, Waltham, MA2012
        View in Article
        • 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. 2022 Feb 8; ([Epub ahead of print])
        View in Article
        • 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
        View in Article
        • Nerenz DR
        • Austin JM
        • Deutscher D
        • et al.
        Adjusting quality measures for social risk factors can promote equity in health care: article examines adjusting quality measures to account for social risk factors.
        Health Aff (Millwood). 2021; 40: 637-644
        View in Article
        • US Department of Health and 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, DC2018
        View in Article
        • Medicare Payment Advisory Commission
        Report to Congress: Medicare and the health care delivery system.
        Medicare Payment Advisory Commission, Washington, DC2019
        View in Article

      22. Centers for Medicare & Medicaid Services. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Measures Information. Available at:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/IRF-Quality-Reporting/IRF-Quality-Reporting-Program-Measures-Information-.html. Accessed October 30, 2021.

        View in Article

      Article info

      Publication history

      Published online: March 08, 2022
      Accepted: March 1, 2022
      Received in revised form: February 3, 2022
      Received: August 11, 2021

      Footnotes

      Current affiliation for McMullen: U.S. Department of Veterans Affairs, Washington, DC.

      Supported by the Centers for Medicare & Medicaid Services (CMS) under contract HHSM-500-2013-13015I and RTI International.

      Disclosures: none.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2022.03.001

      Copyright

      © 2022 by the American Congress of Rehabilitation Medicine.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX