Quality Indicators Prospectively Associated With Falls in Inpatient Rehabilitation Facilities

Retrospective studies suggest quality indicators are associated with falls in inpatient rehabilitation facilities, but this claim has not yet been validated prospectively. The aim of this study was to analyze the associations between quality indicator codes and falls in a prospective sample.

For this prospective observational cohort study, we followed 658 patients from four inpatient rehabilitation facilities who were consecutively admitted and discharged over a 6-mo period. On admission, we collected patients' quality indicator codes, and then, tracked whether they fell during their inpatient rehabilitation facility stay.

Univariable logistic regressions revealed that most individual quality indicator items for communication, self-care, and mobility were significantly associated with falls. In a multivariable model with six different quality indicator items, only patients' performance going up and down one step was significantly associated with falls. To explain this finding, we investigated the relationships between these quality indicator items and found three of them to be highly correlated.

Most individual quality indicator items seem prospectively associated with falls. Patients with lower quality indicator codes are more likely to fall. Combining quality indicator items (such as expression and toileting) may improve fall-risk assessment, but some quality indicator items may be too interrelated to use together.