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

Publication ,  Journal Article
Middleton, A; Graham, JE; Lin, Y-L; Goodwin, JS; Bettger, JP; Deutsch, A; Ottenbacher, KJ
Published in: J Gen Intern Med
December 2016

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2016

Volume

31

Issue

12

Start / End Page

1427 / 1434

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Subacute Care
  • Self Care
  • Retrospective Studies
  • Patient Readmission
  • Motor Skills
  • Medicare
  • Male
  • Insurance Benefits
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Middleton, A., Graham, J. E., Lin, Y.-L., Goodwin, J. S., Bettger, J. P., Deutsch, A., & Ottenbacher, K. J. (2016). Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries. J Gen Intern Med, 31(12), 1427–1434. https://doi.org/10.1007/s11606-016-3704-4
Middleton, Addie, James E. Graham, Yu-Li Lin, James S. Goodwin, Janet Prvu Bettger, Anne Deutsch, and Kenneth J. Ottenbacher. “Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries.J Gen Intern Med 31, no. 12 (December 2016): 1427–34. https://doi.org/10.1007/s11606-016-3704-4.
Middleton A, Graham JE, Lin Y-L, Goodwin JS, Bettger JP, Deutsch A, et al. Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries. J Gen Intern Med. 2016 Dec;31(12):1427–34.
Middleton, Addie, et al. “Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries.J Gen Intern Med, vol. 31, no. 12, Dec. 2016, pp. 1427–34. Pubmed, doi:10.1007/s11606-016-3704-4.
Middleton A, Graham JE, Lin Y-L, Goodwin JS, Bettger JP, Deutsch A, Ottenbacher KJ. Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries. J Gen Intern Med. 2016 Dec;31(12):1427–1434.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2016

Volume

31

Issue

12

Start / End Page

1427 / 1434

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Subacute Care
  • Self Care
  • Retrospective Studies
  • Patient Readmission
  • Motor Skills
  • Medicare
  • Male
  • Insurance Benefits