Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation

Abstract

Objective: To examine the effects of facility-level acute-postacute continuity on probability of community discharge and 30-day rehospitalization following inpatient rehabilitation.

Data sources: We used national Medicare enrollment, claims, and assessment data to study 541,097 patients discharged from 1,156 inpatient rehabilitation facilities (IRFs) in 2010-2011.

Study design: We calculated facility-level continuity as the percentages of an IRF's patients admitted from each contributing acute care hospital. Patients were categorized into three groups: low continuity (<26 percent from same hospital that discharged the patient), medium continuity (26-75 percent from same hospital), or high continuity (>75 percent from same hospital). The multivariable models included an interaction term to examine the potential moderating effects of facility type (freestanding facility vs. hospital-based rehabilitation unit) on the relationships between facility-level continuity and our two outcomes: community discharge and 30-day rehospitalization.

Principal findings: Medicare beneficiaries in hospital-based rehabilitation units were more likely to be referred from a high-contributing hospital compared to those in freestanding facilities. However, the association between higher acute-postacute continuity and desirable outcomes is significantly better in freestanding rehabilitation facilities than in hospital-based units.

Conclusions: Improving continuity is a key premise of health care reform. We found that both observed referral patterns and continuity-related benefits differed markedly by facility type. These findings provide a starting point for health systems establishing or strengthening acute-postacute relationships to improve patient outcomes in this new era of shared accountability and public quality reporting programs.

Keywords: Medicare; Referrals and referral networks; hospitals; quality of care/patient safety (measurement); rehabilitation services.

Figure 1

Distribution of Total IRF Patients by the Proportion of Patients from the Same Referring Hospital

Figure 2

Adjusted Probabilities for Community Discharge by IRF Type and the Three‐Category Facility‐Level Continuity Variable Note. Values are Based on the average patient and parameter estimates from Table 2.

Figure 3

Adjusted Probabilities for 30‐Day Rehospitalization by IRF Type and the Three‐Category Facility‐Level Continuity Variable Note. Values are based on the average patient and parameter estimates from Table 2.