Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

Addie Middleton, James E. Graham, Yu Li Lin, James Goodwin, Janet Prvu Bettger, Anne Deutsch, Kenneth Ottenbacher

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012–2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012–2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42–1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27–1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09–1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3–17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3–8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS: The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Jul 20 2016

Fingerprint

Subacute Care
Fee-for-Service Plans
Medicare
Self Care
Rehabilitation
Cognition
Episode of Care
Independent Living
Centers for Medicare and Medicaid Services (U.S.)
Inpatients
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries. / Middleton, Addie; Graham, James E.; Lin, Yu Li; Goodwin, James; Bettger, Janet Prvu; Deutsch, Anne; Ottenbacher, Kenneth.

In: Journal of General Internal Medicine, 20.07.2016, p. 1-8.

Research output: Contribution to journalArticle

@article{f6511751f21547b88afb4678a1af7723,
title = "Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries",
abstract = "BACKGROUND: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012–2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012–2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 {\%} (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 {\%} increased odds of rehospitalization (OR = 1.50, 95 {\%} CI: 1.42–1.59), patients dependent for self-care a 36 {\%} increased odds (OR = 1.36, 95 {\%} CI: 1.27–1.47), and patients dependent for cognition a 19 {\%} increased odds (OR = 1.19, 95 {\%} CI: 1.09–1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 {\%}) had a 16.1 {\%} (95 {\%} CI: 15.3–17.0 {\%}) adjusted rehospitalization rate versus 8.5 {\%} (95 {\%} CI: 8.3–8.8 {\%}) for those independent for both (n = 74,641; 29.6 {\%}). CONCLUSIONS: The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.",
author = "Addie Middleton and Graham, {James E.} and Lin, {Yu Li} and James Goodwin and Bettger, {Janet Prvu} and Anne Deutsch and Kenneth Ottenbacher",
year = "2016",
month = "7",
day = "20",
doi = "10.1007/s11606-016-3704-4",
language = "English (US)",
pages = "1--8",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

AU - Middleton, Addie

AU - Graham, James E.

AU - Lin, Yu Li

AU - Goodwin, James

AU - Bettger, Janet Prvu

AU - Deutsch, Anne

AU - Ottenbacher, Kenneth

PY - 2016/7/20

Y1 - 2016/7/20

N2 - BACKGROUND: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012–2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012–2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42–1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27–1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09–1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3–17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3–8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS: The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

AB - BACKGROUND: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012–2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012–2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42–1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27–1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09–1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3–17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3–8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS: The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

UR - http://www.scopus.com/inward/record.url?scp=84979300657&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979300657&partnerID=8YFLogxK

U2 - 10.1007/s11606-016-3704-4

DO - 10.1007/s11606-016-3704-4

M3 - Article

SP - 1

EP - 8

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -