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Apparent changes in inpatient rehabilitation facility outcomes due to a change in the definition of program
Anne Deutsch1, Carl V Granger, Carol Russell
1Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA. a-deutsch@northwestern.edu
Objective:
To describe changes in inpatient rehabilitation facility (IRF) outcomes due to the program interruption definitional change, from 30 days to 3 days, in 2002.
Design:
Secondary data analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database.
Setting:
Four hundred eleven IRFs that submitted data to the UDSMR database in each of the years 1998 through 2003.
Participants:
Patient assessment data for 772,584 Medicare fee-for-service beneficiaries.
Interventions:
None.
Main Outcome Measures:
The number of IRF patient discharges, percent of IRF patients discharged to the community, percent of IRF patients discharged to acute care, percent of IRF patients with program interruptions, percent of IRF inpatient deaths, and average IRF length of stay (LOS).
Results:
IRF outcomes appeared to change because of the program interruption redefinition, with changes varying by impairment group. The largest changes due to the redefinition occurred for patients with traumatic spinal cord injury, including the largest percentage increase in patients (5.16%), the largest decrease in program interruptions (5.14%), the largest increase in acute care discharges (5.04%), and the largest mean decrease in LOS (1.27d). Community discharge showed the largest decrease for patients with Guillain-Barré syndrome (4.03%).
Conclusion:
The change in the definition of program interruptions creates the appearance of changes in IRF performance and is important to consider when comparing the preprospective payment system (PPS) and PPS assessment data.
Insights
The 2002 change in inpatient rehabilitation facility (IRF) program interruption definition altered outcome reporting. This redefinition impacted various patient groups, notably those with spinal cord injuries, affecting discharge and length of stay metrics.
Area of Science:
- Healthcare outcomes research
- Rehabilitation medicine
- Health services research
Background:
- The definition of program interruption in inpatient rehabilitation facilities (IRFs) changed in 2002, shifting from 30 days to 3 days.
- This definitional change potentially impacts the interpretation of IRF performance metrics.
Purpose of the Study:
- To analyze the impact of the 2002 program interruption definitional change on inpatient rehabilitation facility (IRF) outcomes.
- To identify how these changes varied across different patient impairment groups.
Main Methods:
- Secondary data analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database.
- Inclusion of 411 IRFs and 772,584 Medicare fee-for-service beneficiaries from 1998-2003.
- Assessment of key outcomes including discharge destinations, program interruptions, inpatient deaths, and length of stay.
Main Results:
- IRF outcomes appeared to change following the program interruption redefinition, with variations observed across impairment groups.
- Patients with traumatic spinal cord injury showed the most significant changes, including increased patient numbers, decreased program interruptions, increased acute care discharges, and reduced length of stay.
- Patients with Guillain-Barré syndrome experienced the largest decrease in community discharge rates.
Conclusions:
- The alteration in the program interruption definition created an apparent shift in IRF performance.
- It is crucial to consider this definitional change when comparing pre-prospective payment system (PPS) and PPS assessment data for accurate performance evaluation.
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