Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture

Self Cite

Objective To examine the influence of facility and aggregate patient characteristics of inpatient rehabilitation facilities (IRFs) on performance-based rehabilitation outcomes in a national sample of IRFs treating Medicare beneficiaries with hip fracture. Design Secondary data analysis. Setting U.S. Medicare-certified IRFs (N=983). Participants 983 US Medicare-certified IRFs. Data included 34,364 patient records of Medicare beneficiaries admitted in 2009 for rehabilitation after hip fracture. Main Outcome Measures Performance-based outcomes included mean motor function on discharge, mean motor change (mean motor score on discharge minus mean motor score on admission) and percentage discharged to the community. Results Higher mean motor function on discharge was explained by aggregate characteristics of hip fracture patients (lower age [p=0.009], lower percentage of Blacks [p<0.001] and Hispanics [p<0.001], higher percentage of females [p<0.030], higher motor function on admission [p<0.001], longer length of stay [p<0.001]) and facility characteristics (freestanding [p<0.001], rural [p<0.001], for-profit [p=0.048], and smaller IRFs [p=0.041]). The findings were similar for motor change, but motor change was also associated with lower mean cognitive function on admission (0.008). Higher percentage discharged to the community was associated with aggregate patient characteristics (lower age [p<0.001], lower percentage of Hispanics [p=0.009], higher percentage of patients living with others [p<0.001], and higher motor function on admission [p<0.001]). No facility characteristics were associated with percentage discharged to the community. Conclusion Performance-based measurement offers health policymakers, administrators, clinicians, and consumers a major opportunity for securing health system improvement by benchmarking or comparing their outcomes to other similar facilities. These results might serve as the basis for benchmarking and quality-based reimbursement to IRFs for one impairment group: hip fracture.

Section: Discussionsupporting

confidence: 90%

Performance-Based Outcomes of Inpatient Rehabilitation Facilities Treating Hip Fracture Patients in the United States

Cary

Baernholdt

Anderson

et al. 2015

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“…This is consistent with previous studies indicating hip fracture patients who lived with others prior to admission had poorer self-care and mobility scores at admission. 2,10 …”

Section: Discussionmentioning

confidence: 99%

“…Andersen’s model for health services use (Figure 1) 13,14 and evidence from previous research 6,10 was used to identify variables for inclusion in this study. Andersen’s model posits that outcomes of care are influenced by factors in three domains: (1) contextual factors, including the external environment (the economic, political, and social context in which health systems operate) and facility characteristics (how the health system is structured to deliver care); (2) individual factors including predisposing (age, race, gender), enabling (social support), and need-factors (health status); and (3) healthcare access (use of IRF services).…”

Section: Methodsmentioning

confidence: 99%

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

Cary

Pan

Sloane

et al. 2016

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Objective To examine contextual (facility and community) and individual factors associated with self-care and mobility outcomes among Medicare hip fracture patients receiving inpatient rehabilitation. Design Retrospective cohort study of 3 linked data files: Inpatient Rehabilitation Facility-Patient Assessment Instrument, Provider of Services, and Area Health Resources. Multilevel modeling was used to examine the effects of contextual and individual factors on self-care and mobility outcomes. Setting Inpatient Rehabilitation Facilities (IRFs). Participants Medicare hip fracture patients (N=35,264) treated in IRFs (N = 1072) in 2012. Interventions Not applicable. Main Outcome Measure(s) Self-care (eating, grooming, bathing, upper and lower body dressing, and toileting) and mobility (walk/wheelchair and stairs) at discharge. Results Mean age was 81 years. Mean self-care and mobility scores at admission were 3.17 (SD=0.87) and 1.24, (SD=0.51), respectively; mean self-care and mobility scores at discharge were 5.03 (SD=1.09) and 3.31 (SD=1.54), respectively. Individual and contextual levels explained 44.4% and 21.6% of the variance in self-care at discharge and 19.5% and 1.9% of the variance in mobility at discharge, respectively. Individual level, age, race/ethnicity, cognitive and motor FIM scores at admission, and Tier comorbidities explained variance in self-care and mobility; gender and length of stay explained variance only in self-care. At the contextual level, facilities’ case mix (mean patient age, percent Non-Hispanic White, mean self-care score at admission) and structural characteristics (rural location, freestanding, and for-profit ownership) explained variance only in self-care; facilities’ case mix (mean patient age, percent Non-Hispanic White, percent living with social support, and mean mobility score at admission) explained variance in mobility. Community variables were non-significant. Conclusion Individual and facility factors were significant predictors of discharge self-care and mobility among Medicare hip fracture patients in IRFs. Findings may improve quality of IRF services to hip fracture patients and inform risk adjustment methods.

“…Others have shown that social support is strongly associated with discharge destination. 7,9,17 Young and colleagues 18 also recently concluded that caregiver commitment, capacity, and preparedness are key factors in ‘long-term’ outcomes for patients with stroke following discharge from inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…Social support, for example, is associated with likelihood of returning to the community. 7–9 It is unknown whether social support is similarly associated with likelihood of shorter- or longer-than-expected lengths of stay.…”

mentioning

confidence: 99%

Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities

Lewis

Hay

Graham

et al. 2016

Objectives Describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation and examine the independent effects of social support on deviations from expected lengths of stay. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities across the United States. Participants Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 following stroke, lower extremity fracture, or lower extremity joint replacement. Intervention Not applicable. Main Outcome Measure Relative length of stay (actual – expected). The Centers for Medicare and Medicaid Services posts annual expected lengths of stay based on patients’ clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. Results Mean (SD) actual lengths of stay for joint replacement, fracture, and stroke were 9.8 (3.6), 13.8 (4.5), and 15.8 (7.3) days, respectively; relative lengths of stay were −1.2 (3.1), −1.6 (3.7), and −1.7 (5.2) days. Nearly half of patients (47–48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (p<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement. Conclusion Inpatient rehabilitation experiences and outcomes can be substantially impacted by a patient’s level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures.