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, 2016 12.
Article
en En
| MEDLINE
| ID: mdl-27439979
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. MAINMEASURES:
Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEYRESULTS:
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Readmisión del Paciente
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Medicare
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Cognición
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Planes de Aranceles por Servicios
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Atención Subaguda
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Destreza Motora
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Gen Intern Med
Asunto de la revista:
MEDICINA INTERNA
Año:
2016
Tipo del documento:
Article
País de afiliación:
Estados Unidos