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. 2016 Dec;31(12):1427-1434.
doi: 10.1007/s11606-016-3704-4. Epub 2016 Jul 20.

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

Addie Middleton  1 , James E Graham  2 , Yu-Li Lin  3 , James S Goodwin  4 , Janet Prvu Bettger  5 , Anne Deutsch  6 , Kenneth J Ottenbacher  2
Affiliations

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

Addie Middleton et al. J Gen Intern Med. 2016 Dec.

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.

Keywords: functional status; health care reform; health services research; medicare; rehabilitation.

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Conflict of interest statement

Compliance with Ethical Standards Funders The study was supported by the National Institutes of Health (R24-HD065702, R01-HD069443 and 5K12HD055929-09, PI, K. Ottenbacher) and the National Institute for Disability, Independent Living, and Rehabilitation Research (H133G140127, PI, K. Ottenbacher). Conflict of Interest The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart presenting number and percent of eligible patients remaining at each step as exclusion criteria were applied.
Figure 2.
Figure 2.
Adjusted 30-day unplanned rehospitalization rates by functional classification within each domain. The dashed line represents the unadjusted 30-day unplanned rehospitalization rate for the sample (12.0 %).
Figure 3.
Figure 3.
Adjusted 30-day unplanned rehospitalization rates for all combinations of discharge self-care and mobility functional categories. The dashed line represents the unadjusted 30-day unplanned rehospitalization rate for the sample (12.0 %).* The dependent for self-care and independent for mobility cell was censored due to inadequate size (n = 14; 0.0 %).
See this image and copyright information in PMC

Comment in

  • And Now Post-Post-Acute Care Transitions.
    Jencks SF, Lynn J. Jencks SF, et al. J Gen Intern Med. 2016 Dec;31(12):1410-1411. doi: 10.1007/s11606-016-3770-7. J Gen Intern Med. 2016. PMID: 27312094 Free PMC article. No abstract available.

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