Defining and Measuring Delays in Postacute Care: Toward a Standardized Definition of Rehabilitation Access

Studying delays in postacute care (PAC) rehabilitation using Medicare data is challenging due to the absence of a standardized definition of PAC access timeframes across rehabilitation provider types.

We used 100% Medicare claims data for beneficiaries aged 66 and older discharged to PAC with one of 8 common medical conditions. PAC initiation was examined for inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). Daily utilization curves were generated for each PAC setting. Joinpoint regression identified the time points where the rate of PAC initiation changed significantly, based on 2019 data. These joinpoints mark thresholds beyond which fewer patients accessed PAC at a slower pace and were used to define delayed access for each setting. We evaluated the stability of joinpoints using 2018 data.

Among over 8.9 million hospitalizations, IRFs and SNFs showed a consistent joinpoint at day 2 postdischarge. In contrast, HHA access increased more gradually, with a joinpoint at day 12.

Patients typically access facility-based PAC (IRF and SNF) within 2 days, whereas initiation of home-based PAC (HHA) occurs around 12 days. These findings on the joinpoint provide empirical evidence to define PAC delay for each setting. However, it also indicates a systemic gap in defining timely postacute transitions, underscoring the need for standardizing the lengths of accessing postacute services with empirical evidence.