Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

Abstract

BACKGROUND:The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012-2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42-1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27-1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09-1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3-17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3-8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS:The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

Transitions From Skilled Nursing Facility to Home: The Relationship of Early Outpatient Care to Hospital Readmission

“…13,30,33 Having Medicaid insurance, which may be a proxy for more disadvantaged socioeconomic status, was associated with readmission in bivariate analysis but was no longer significant in the multivariable model. Currently, the nursing home hospital readmission penalty adjusts for gender because women are thought to be significantly lower risk for readmission.…”

Activities of Daily Living of Home Healthcare Patients

“…The importance of ADLs is reflected in the passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Centers for Medicare and Medicaid Services [CMS], 2015) which mandates the standardization of functional status measures across all PAC settings. Under the IMPACT Act, functional status is represented by self-care and mobility ADLs (Middleton et al, 2016).…”

Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes

“…With the exception of falls and pressure ulcers, which are often the focus of hospital quality improvement efforts, the presence of geriatric syndromes is rarely communicated to the next provider at discharge [18]. Geriatric syndromes can weaken a patient’s functional status at hospital discharge, and a decline in mobility, self-care, and cognition have all been linked to an elevated risk of unplanned readmission within 30 days of hospital discharge [19,20,21]. Furthermore, the polypharmacy associated with multiple comorbidities common among older patients complicates medication regimens and increases the risk of poor medication adherence and medication errors, thereby increasing the risk of adverse drug events that contribute to readmissions [22,23,24,25,26].…”