Facility and Geographic Variation in Rates of Successful Community Discharge After Inpatient Rehabilitation Among Medicare Fee-for-Service Beneficiaries

Addie Middleton, James E. Graham, Janet Prvu Bettger, Allen Haas, Kenneth Ottenbacher

    Research output: Contribution to journalArticle

    Abstract

    Importance: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a quality measure of successful community discharge for postacute care services. Examining variation in performance nationally can help identify opportunities for improving patient-centered quality of care. Objective: To examine US facility-level and geographic variation in rates of successful community discharges after inpatient rehabilitation. Design, Setting, and Participants: This retrospective cohort study of Medicare claims data from December 31, 2013, through October 1, 2015, included 1154 inpatient rehabilitation facilities submitting claims to the Centers for Medicare & Medicaid Services and a total of 487 862 Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities. Analyses were performed from December 8, 2017, through September 11, 2018. Main Outcomes and Measures: Successful community discharge as defined for the Discharge to Community-Post-Acute Care Inpatient Rehabilitation Facility Quality Reporting Program measure. To be considered a successful community discharge, patients had to discharge from the inpatient rehabilitation facility to the community (ie, home or self-care) and remain there without experiencing an unplanned rehospitalization or dying within the following 31 days. Centers for Medicare & Medicaid Services specifications were followed to identify the cohort, define the outcome, and calculate risk-standardized facility and state rates. Results: Among the 487 862 patients included in the cohort, mean (SD) age was 76.4 (10.8) years, and 56.9% were female. The overall rate of successful community discharge after inpatient rehabilitation was 63.7% (95% CI, 63.6%-63.8%). Risk-standardized rates ranged from 42.9% to 83.6% across inpatient rehabilitation facilities. Two hundred sixteen facilities (18.7%) performed significantly better than the mean national rate and 203 (17.6%) performed significantly worse (P < .05). Risk-standardized state rates ranged from 55.9% to 73.3%. Rates were lowest in the Northeast (Massachusetts, 55.9%; New Hampshire, 57.0%) and highest in the West (Oregon, 70.3%; Hawaii, 73.3%). Conclusions and Relevance: The observed variation suggests opportunities exist for improving this important, patient-centered national quality measure. Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge. These findings can be used to guide care improvement efforts and further improve the consistency and quality of postacute care.

    Original languageEnglish (US)
    Pages (from-to)e184332
    JournalJAMA network open
    Volume1
    Issue number7
    DOIs
    StatePublished - Nov 2 2018

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    Fee-for-Service Plans
    Medicare
    Inpatients
    Subacute Care
    Rehabilitation
    Quality of Health Care
    Medicaid
    Patient-Centered Care
    Patient Discharge
    Social Welfare
    Self Care
    Cohort Studies
    Retrospective Studies
    Outcome Assessment (Health Care)

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    Facility and Geographic Variation in Rates of Successful Community Discharge After Inpatient Rehabilitation Among Medicare Fee-for-Service Beneficiaries. / Middleton, Addie; Graham, James E.; Prvu Bettger, Janet; Haas, Allen; Ottenbacher, Kenneth.

    In: JAMA network open, Vol. 1, No. 7, 02.11.2018, p. e184332.

    Research output: Contribution to journalArticle

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    abstract = "Importance: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a quality measure of successful community discharge for postacute care services. Examining variation in performance nationally can help identify opportunities for improving patient-centered quality of care. Objective: To examine US facility-level and geographic variation in rates of successful community discharges after inpatient rehabilitation. Design, Setting, and Participants: This retrospective cohort study of Medicare claims data from December 31, 2013, through October 1, 2015, included 1154 inpatient rehabilitation facilities submitting claims to the Centers for Medicare & Medicaid Services and a total of 487 862 Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities. Analyses were performed from December 8, 2017, through September 11, 2018. Main Outcomes and Measures: Successful community discharge as defined for the Discharge to Community-Post-Acute Care Inpatient Rehabilitation Facility Quality Reporting Program measure. To be considered a successful community discharge, patients had to discharge from the inpatient rehabilitation facility to the community (ie, home or self-care) and remain there without experiencing an unplanned rehospitalization or dying within the following 31 days. Centers for Medicare & Medicaid Services specifications were followed to identify the cohort, define the outcome, and calculate risk-standardized facility and state rates. Results: Among the 487 862 patients included in the cohort, mean (SD) age was 76.4 (10.8) years, and 56.9{\%} were female. The overall rate of successful community discharge after inpatient rehabilitation was 63.7{\%} (95{\%} CI, 63.6{\%}-63.8{\%}). Risk-standardized rates ranged from 42.9{\%} to 83.6{\%} across inpatient rehabilitation facilities. Two hundred sixteen facilities (18.7{\%}) performed significantly better than the mean national rate and 203 (17.6{\%}) performed significantly worse (P < .05). Risk-standardized state rates ranged from 55.9{\%} to 73.3{\%}. Rates were lowest in the Northeast (Massachusetts, 55.9{\%}; New Hampshire, 57.0{\%}) and highest in the West (Oregon, 70.3{\%}; Hawaii, 73.3{\%}). Conclusions and Relevance: The observed variation suggests opportunities exist for improving this important, patient-centered national quality measure. Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge. These findings can be used to guide care improvement efforts and further improve the consistency and quality of postacute care.",
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    AU - Middleton, Addie

    AU - Graham, James E.

    AU - Prvu Bettger, Janet

    AU - Haas, Allen

    AU - Ottenbacher, Kenneth

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    N2 - Importance: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a quality measure of successful community discharge for postacute care services. Examining variation in performance nationally can help identify opportunities for improving patient-centered quality of care. Objective: To examine US facility-level and geographic variation in rates of successful community discharges after inpatient rehabilitation. Design, Setting, and Participants: This retrospective cohort study of Medicare claims data from December 31, 2013, through October 1, 2015, included 1154 inpatient rehabilitation facilities submitting claims to the Centers for Medicare & Medicaid Services and a total of 487 862 Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities. Analyses were performed from December 8, 2017, through September 11, 2018. Main Outcomes and Measures: Successful community discharge as defined for the Discharge to Community-Post-Acute Care Inpatient Rehabilitation Facility Quality Reporting Program measure. To be considered a successful community discharge, patients had to discharge from the inpatient rehabilitation facility to the community (ie, home or self-care) and remain there without experiencing an unplanned rehospitalization or dying within the following 31 days. Centers for Medicare & Medicaid Services specifications were followed to identify the cohort, define the outcome, and calculate risk-standardized facility and state rates. Results: Among the 487 862 patients included in the cohort, mean (SD) age was 76.4 (10.8) years, and 56.9% were female. The overall rate of successful community discharge after inpatient rehabilitation was 63.7% (95% CI, 63.6%-63.8%). Risk-standardized rates ranged from 42.9% to 83.6% across inpatient rehabilitation facilities. Two hundred sixteen facilities (18.7%) performed significantly better than the mean national rate and 203 (17.6%) performed significantly worse (P < .05). Risk-standardized state rates ranged from 55.9% to 73.3%. Rates were lowest in the Northeast (Massachusetts, 55.9%; New Hampshire, 57.0%) and highest in the West (Oregon, 70.3%; Hawaii, 73.3%). Conclusions and Relevance: The observed variation suggests opportunities exist for improving this important, patient-centered national quality measure. Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge. These findings can be used to guide care improvement efforts and further improve the consistency and quality of postacute care.

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