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Performance-based outcomes of inpatient rehabilitation facilities treating hip fracture patients in the United States.

Abstract：

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:Data included patient records of Medicare beneficiaries (N=34,364) admitted in 2009 for rehabilitation after hip fracture. INTERVENTION:Not applicable. 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 patients with hip fracture (lower age [P=.009], lower percentage of blacks [P<.001] and Hispanics [P<.001], higher percentage of women [P=.030], higher motor function on admission [P<.001], longer length of stay [P<.001]) and facility characteristics (freestanding [P<.001], rural [P<.001], for profit [P=.048], smaller IRFs [P=.014]). The findings were similar for motor change, but motor change was also associated with lower mean cognitive function on admission (P=.008). Higher percentage discharged to the community was associated with aggregate patient characteristics (lower age [P<.001], lower percentage of Hispanics [P=.009], higher percentage of patients living with others [P<.001], higher motor function on admission [P<.001]). No facility characteristics were associated with the percentage discharged to the community. CONCLUSIONS:Performance-based measurement offers health policymakers, administrators, clinicians, and consumers a major opportunity for securing health system improvement by benchmarking or comparing their outcomes with those of other similar facilities. These results might serve as the basis for benchmarking and quality-based reimbursement to IRFs for 1 impairment group: hip fracture.

journal_name

Arch Phys Med Rehabil

journal_title

Archives of physical medicine and rehabilitation

authors

Cary MP,Baernholdt M,Anderson RA,Merwin EI

doi

10.1016/j.apmr.2015.01.003

subject

Has Abstract

pub_date

2015-05-01 00:00:00

pages

790-8

issue

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(15)00007-6

journal_volume

pub_type

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Performance-based outcomes of inpatient rehabilitation facilities treating hip fracture patients in the United States.