Abstract 2224: The Relationship Between Process and Outcomes for Stroke Post Prospective Payment in Inpatient Rehabilitation Facilities

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Suzanne R O'Brien ◽  
Gail Ingersoll ◽  
Ying Xue ◽  
Adam Kelly ◽  
Din Chen
Keyword(s):  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Assessment Instrument ◽  
Discharge Destination ◽  
Medicare Beneficiaries ◽  
Prospective Payment ◽  
Rehabilitation Facilities ◽  
Race Ethnicity ◽  
Stroke Type ◽  
The Relationship

Background and Objective: Previous studies have reported decreasing length of stay (LOS) for inpatient rehabilitation facilities (IRFs), with conflicting effects on discharge Functional Independence Measure (FIM) scores and discharge destination (DD). This study was the first to examine the post prospective payment system (PPS) period using Medicare data drawn from the national Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) database. The purposes were to examine trends over time for process and outcome factors, and to describe the relationships between process, LOS, and outcomes (discharge FIM scores and DD), for Medicare patients with stroke. Methods: The study included 371,211 Medicare Part A beneficiaries aged 65 and older with stroke, admitted to United States (US) IRFs between January 1, 2002 and June 30, 2007. Descriptive statistics and generalized estimating equations (GEE) modeling for clustered data were used for analysis. Continuous GEE evaluated LOS and discharge FIM scores, and binomial GEE evaluated LOS and DD (community verses institution). Covariates in models were: admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type. Time interactions with admission FIM scores, LOS, and discharge FIM scores (binomial model only) were examined. Results: During the study period, mean LOS decreased from 17.9 (SD=9.9) to 16.1(SD=8.3) days (p<. 0001), mean discharge FIM scores decreased from 80.1 (SD=24.5) to 76.5 (SD=24.5) points (p<. 0001), and rate of community discharge decreased from 66.6% to 61.2% (p<. 0001). LOS predicted discharge FIM scores (95% CI, .48, .52, p<.0001), but the relationship to community discharge was weak (OR .997, p=.007). Discharge FIM scores predicted discharge destination (OR 1.07, p<.0001). Covariates of admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type also predicted outcomes. Time interactions were present for LOS, admission FIM scores, and discharge FIM scores. Conclusions: During the first 5.5 years of PPS, declining trends were found for LOS, discharge FIM scores, and rate of community discharge for Medicare beneficiaries with stroke. LOS was a strong predictor for discharge FIM scores, but weak for DD. Discharge FIM scores were a better predictor of DD than LOS. Effects of covariates on discharge FIM scores and DD have clinical implications for IRF stroke rehabilitation in the US. Because of the reduced time for treatment, dose of IRF rehabilitation for Medicare beneficiaries may not be achieving expected results in the post-PPS period.

scholarly journals Influence of Frailty on Discharge Setting for Older Adults With Hip Fracture at Inpatient Rehabilitation Facilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Christine Tocchi ◽  
Shamatree Shakya ◽  
Sathya Amarasekara ◽  
Michael Cary
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Functional Status ◽  
Hip Fractures ◽  
Value Added ◽  
Inpatient Rehabilitation ◽  
Assessment Instrument ◽  
Discharge Destination ◽  
White Race ◽  
Rehabilitation Facilities

Abstract Inpatient rehabilitation Facilities (IRFs) provide intensive rehabilitation therapy to patients to reduce functional impairment, enhance independence and return patients back to the community. Determination of eligibility for IRF is currently based on a preadmission screening. Frailty, a pervasive characteristic in older adults with hip fractures has not been examined as a clinical factor influencing function and discharge destination IRF outcomes. This study purpose was to determine the prevalence of frailty among older adult IRF patients with hip fractures and determine the association between frailty and function and discharge destination among IRF hip fracture patients. A retrospective cohort study design using CMS 2014 Inpatient Rehabilitation Facility-Patient Assessment Instrument file. Frailty was measured using a Frailty Index of 30 items. The final sample included 26,134 patients. Frailty, pre-frailty, and nonfrailty were present in 0.92% (n=24043), 3.3% (n=862), and .076% (n=199) of hip fracture patients, respectively. The majority (65%) of the patients were discharged home. There were significantly greater proportion of females than males discharged home and those of white race, 65 to 74 years of age, and those with higher functional status. Regression analysis showed significantly lower functional status at discharge (p &lt; .0001) for males and those of non-white race, older age and frail. Study implications include the use of frailty status to identify hip fracture patients at high risk for adverse outcomes and need for future studies to explore the potential of frailty to provide value-added utility to IRF clinical settings and identify ongoing opportunities to guide person-centered care.

Outcomes and Reimbursement of Inpatient Rehabilitation Facilities and Subacute Rehabilitation Programs for Medicare Beneficiaries With Hip Fracture

Medical Care ◽  
2005 ◽  
Vol 43 (9) ◽  
pp. 892-901 ◽  
Author(s):  
Anne Deutsch ◽  
Carl V. Granger ◽  
Roger C. Fiedler ◽  
Gerben DeJong ◽  
Robert L. Kane ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Inpatient Rehabilitation ◽  
Medicare Beneficiaries ◽  
Rehabilitation Programs ◽  
Rehabilitation Facilities

Abstract TP160: What Matters Most? Predictors of Poststroke Functional Outcomes From Inpatient Rehabilitation Facilities Across the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
James J García ◽  
Karlita L Warren ◽  
Fengmei Gong ◽  
Honggang Wang
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Sociodemographic Factors ◽  
Administrative Database ◽  
Cross Sectional ◽  
Rehabilitation Facilities ◽  
Stroke Type

Introduction: Stroke is one of the leading cause of disability and death in the United States (Benjamin et al., 2018). Inpatient rehabilitation is the gold standard treatment for post-acute care (Weinstein et al., 2016). Data indicate a discharge to inpatient rehabilitation facilities (IRFs) following the acute stroke phase has increased (Buntin, Colla, & Escarce, 2009). The inpatient milieu provides a unique opportunity to examine predictors of functional outcomes using a captive sample. Thus, the current study aim is to identify factors associated with poststroke functional outcomes throughout inpatient rehabilitation. Method: This is a cross-sectional and retrospective analysis of data extracted from an administrative database during years 2005-2016 from 244,286 stroke patients across 30% of IRFs in the U.S. Inclusion criteria were patients at or above the age 18 with stroke as an admitting diagnosis using ICD 9/10 codes 430-438/I60-I69. Dependent variables were: admission Total FIM, Total FIM efficiency, discharge Total FIM, and length of stay (LOS). Results: Using separate regression analyses, marital status, admit year, type of admission, race/ethnicity, insurance type, sex, age, number of complications, number of comorbidities, and stroke type, emerged as significant predictors of functional outcomes throughout inpatient rehabilitation. Moreover, those with greater comorbidities and complications were associated with lower admission FIM total score, less total FIM efficiency, lower discharge FIM total score, and a longer LOS. Compared to NHWs, racial/ethnic people were associated with lower FIM scores throughout inpatient rehabilitation and a longer length of stay. Discussion: In this robust national dataset, data indicate clinical and sociodemographic factors are significantly associated with poststroke functional outcomes throughout inpatient rehabilitation. Implications are discussed within a framework of social determinants of health.

scholarly journals Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older

2016 ◽  
Vol 96 (9) ◽  
pp. 1381-1388 ◽  
Author(s):  
Suzanne R. O'Brien ◽  
Ying Xue
Keyword(s):  
Outcome Measures ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Functional Independence ◽  
Assessment Instrument ◽  
Age Group ◽  
Cross Sectional ◽  
Discharge Outcomes

Abstract Background In the United States, people 85 years of age or older have a growing number of strokes each year, and this age group is most at risk for disability. Inpatient rehabilitation facilities (IRFs) adhere closest to post-acute stroke rehabilitation guidelines and have the most desirable outcomes compared with skilled nursing facilities. As stroke is one of the leading causes of disability, knowledge of postrehabilitation outcomes is needed for this age group, although at present such information is limited. Objective The purpose of this study was to describe functional and discharge outcomes after IRF rehabilitation in people with stroke aged 85 years or older. Design A serial, cross-sectional design was used. Methods Inpatient Rehabilitation Facility–Patient Assessment Instrument data were analyzed beginning in 2002 for the first 5.5 years after implementation of the prospective payment system and included 71,652 cases. Discharge function, measured using the Functional Independence Measure (FIM), and community discharge were the discharge outcome measures. Sample description used frequencies and means. Generalized estimating equations (GEEs) with post hoc testing were used to analyze the annual trends for discharge FIM and community discharge by age group (85–89, 90–94, 95–99, and ≥100 years). Risk-adjusted linear and logistic GEE models, with control for cluster, were used to analyze the association between both outcome measures and age group. Results Over 5.5 years, mean discharge FIM scores decreased by 3.6 points, and mean achievement of community discharge decreased 5.5%. Approximately 54% of the sample achieved community discharge. Continuous and logistic GEEs revealed factors associated with discharge outcomes. Limitations Results obtained using an observational design should not be viewed as indicating causation. The lack of control for a caregiver may have altered results. Conclusions The very elderly people admitted to IRF stroke rehabilitation made functional gains, and most were able to return to the community.

637 Disparities in Discharge Disposition: A Burn Model Systems National Database Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
Stephanie A Mason ◽  
Gretchen J Carrougher ◽  
Karen J Kowalske ◽  
Jeffrey C Schneider ◽  
Dagmar Amtmann ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Model Systems ◽  
System Level ◽  
National Database ◽  
Discharge Destination ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Discharge Care ◽  
Race Ethnicity

Abstract Introduction Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers. Methods Data were derived from the prospectively maintained Burn Model Systems national database. All participants admitted to one of five participating centers between 1994 and 2019, who survived to discharge with a known disposition, were included. The relationship between patient characteristics, injury factors and discharge to home, a skilled nursing facility (SNF), or inpatient rehabilitation was modeled using multinomial generalized estimating equations. Pre-specified stratified analyses were conducted to examine effect modification. Results We identified 4395 participants who met inclusion criteria. Participants were 74% White non-Hispanic (n=3269), 18% Black non-Hispanic (n=812), 3% Hispanic (n=122), 0.5% Asian (n=24), and 4% Other (n=168). Most were aged 18–64 years (68%, n=2998). Overall, 79% (n=3585) of participants were discharged home, 12% to inpatient rehabilitation (n=534), and 6% to SNF (n=276). After adjustment for patient characteristics and injury factors, there were no differences in discharge destination by race/ethnicity. However, subgroup analyses demonstrated effect modification by both center and burn size. At 2 centers, Black participants were significantly more likely to be discharged to SNF or inpatient rehabilitation (Center 1 OR 1.98, 95% CI 1.02–3.85; Center 2 OR 2.36, 95% CI 1.07–5.19). Similarly, among all participants with &gt;20% TBSA, Black participants were more likely to be discharged to SNF or inpatient rehabilitation (OR 1.38, 95% CI 1.06–1.81). Across all groups, having insurance was associated with discharge to SNF or inpatient rehabilitation (OR 1.68, 95% CI 1.21–2.33). Conclusions Although no overall difference in discharge destination by race was identified, stratified analyses indicate disparities in discharge disposition at the patient and system level. At specific centers, and among those with &gt;20% TBSA injury, Black participants are more likely to be discharged to SNF and inpatient rehabilitation than other ethnic groups. Applicability of Research to Practice Both patient and system level factors are associated with discharge to higher levels of post-discharge care, suggesting that further characterization of these factors is warranted. Such data can inform interventions and policy changes aimed at ensuring equitable access to appropriate post-discharge care.

Association of Inpatient Rehabilitation Facilities’ Characteristics and 30–Day Unplanned Hospital Readmissions for Medicare Beneficiaries

2018 ◽  
Vol 72 (4_Supplement_1) ◽  
pp. 7211510162p1
Author(s):  
Chih–Ying Li ◽  
Amol Karmarkar ◽  
Kenneth Ottenbacher ◽  
Yong–Fang Kuo ◽  
Yu–Li Lin ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Inpatient Rehabilitation ◽  
Medicare Beneficiaries ◽  
Rehabilitation Facilities

scholarly journals Gait speed as an indicator of prosthetic walking potential following lower limb amputation

2018 ◽  
Vol 43 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Heather R Batten ◽  
Steven M McPhail ◽  
Allison M Mandrusiak ◽  
Paulose N Varghese ◽  
Suzanne S Kuys
Keyword(s):  
Lower Limb ◽  
Gait Speed ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Transtibial Amputation ◽  
And Function ◽  
The Relationship

Background: The relationship between gait speed and prosthetic potential (K-level classifications) and function has not been explored among people transitioning from hospital rehabilitation to the community. Objectives: To examine gait speed at discharge from inpatient rehabilitation among people prescribed a prosthetic leg after unilateral lower limb amputation, and associations between gait speed, prosthetic potential and functional ability. Study design: Cohort. Methods: Gait speed (10-m walk test), K-level (Amputee Mobility Predictor) and Functional Independence Measure motor were compared for 110 people (mean (standard deviation) age: 63 (13) years, 77% male, 71% transtibial amputation, 70% dysvascular causes). Results: Median (interquartile range) gait speed and Functional Independence Measure motor were 0.52 (0.37–0.67) m/s and 84 (81, 85), respectively. Median (IQR) gait speed scores for each K-level were as follows: K1 = 0.17 (0.15–0.19) m/s, K2 = 0.38 (0.25–0.54) m/s, K3 = 0.63 (0.50–0.71) m/s and K4 = 1.06 (0.95–1.18) m/s. Median (IQR) FIM-Motor scores for each K-level were as follows: K1 = 82 (69–84), K2 = 83 (79–84), K3 = 85 (83–87) and K4 = 87 (86–89). Faster gait speed was associated with higher K-level, higher FIM-Motor, being younger, male and having transtibial amputation with nonvascular aetiology. Conclusion: Gait speed was faster among each higher K-level classification. However, gait speeds observed across all K-levels were slower than healthy populations, consistent with values indicating high risk of morbidity and mortality. Clinical relevance Factors associated with faster gait speed are useful for clinical teams considering walking potential of people with lower limb prostheses and those seeking to refine prosthetic rehabilitation programmes.

scholarly journals Identifying and Accommodating Statistical Outliers When Setting Prospective Payment Rates for Inpatient Rehabilitation Facilities

2004 ◽  
Vol 39 (6p1) ◽  
pp. 1859-1880 ◽  
Author(s):  
Susan M. Paddock ◽  
Barbara O. Wynn ◽  
Grace M. Carter ◽  
Melinda Beeuwkes Buntin
Keyword(s):  
Inpatient Rehabilitation ◽  
Prospective Payment ◽  
Rehabilitation Facilities

scholarly journals Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

2019 ◽  
Vol 46 (6) ◽  
pp. 691-701
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Severe Stroke ◽  
Rehabilitation Care ◽  
Mild Stroke ◽  
The Impact ◽  
Functional Gains

ABSTRACT:Background:We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.Methods:Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.Results:The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10–9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10–9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10–9, partial η2 0.022) and LOS (p = 1.1 × 10–19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.Conclusion:Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

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