The Patient Protection and Affordable Care Act creates a """"""""hospital readmission reduction program"""""""" to help acute care hospitals decrease avoidable rehospitalizations. Research suggests approximately twenty percent of all Medicare patients are rehospitalized within 30 days of discharge from acute care and that the majority of these rehospitalizations are preventable. Research examining rehospitalization has focused primarily on patients discharged from acute care hospitals. We will examine rates and reasons for hospital readmission in high volume and high cost patients, such as those with stroke or hip fracture, who receive inpatient medical rehabilitation. This is an understudied population with important implications for health care resources and costs as the U.S. population continues to age. Our goal is to determine rates and factors associated with hospital readmissions in persons receiving inpatient rehabilitation services for the six largest rehabilitation impairment groups as defined by the Centers for Medicare and Medicaid Services (CMS). We propose the following Specific Aims:
Aim 1. Examine national data from the Centers for Medicare and Medicaid Services and the Uniform Data System for Medical Rehabilitation (UDSMR) to determine rates of hospital readmission for the six largest impairment groups receiving inpatient medical rehabilitation in the U.S. (stroke, fracture of the lower extremity, joint replacement of the lowe extremity, debility, neurological disorders and traumatic brain injury) (MedPAC, 2011).
Aim 2. Determine patient characteristics (sociodemographic and clinical/functional) associated with hospital readmission across the six impairment groups (see Aim 1). We will examine data from the Centers for Medicare and Medicaid Services files and the Uniform Data System for Medical Rehabilitation dataset for the years 2006 - 2010 (~ 1.3 million patient records). We will use exploratory data analysis and descriptive statistics to determine the rate of hospital readmission for the six rehabilitation impairment categories. Time-to-event survival analyses will be used to examine personal and clinical factors associated with hospital readmission during the first 90 days after discharge. Our interdisciplinary research team has twenty years of experience using large national datasets to study rehabilitation outcomes. The findings will address priorities of the Affordable Care Act, provide information useful in developing future predictive models, and assist in documenting hospital accountability and establishing quality indicators.

Public Health Relevance

We will examine the rates and reasons for hospital readmission in high volume and high cost patients such as those who have a stroke or fracture their hip and receive post-acute care services in rehabilitation facilities. The findings will provde information useful in establishing quality indicators for post-acute care and the allocation of resources for persons at high risk for rehospitalization. The results will also address priorities f the Patient Protection and Affordable Care Act by identifying strategies to reduce health care costs.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD069443-02
Application #
8505516
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Quatrano, Louis A
Project Start
2012-07-05
Project End
2016-04-30
Budget Start
2014-05-01
Budget End
2015-04-30
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Texas Medical Br Galveston
Department
Physical Medicine & Rehab
Type
Sch Allied Health Professions
DUNS #
City
Galveston
State
TX
Country
United States
Zip Code
77555
Middleton, Addie; Graham, James E; Deutsch, Anne et al. (2017) Potentially Preventable Within-Stay Readmissions Among Medicare Fee-for-Service Beneficiaries Receiving Inpatient Rehabilitation. PM R 9:1095-1105
Li, Chih-Ying; Karmarkar, Amol; Lin, Yu-Li et al. (2017) Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated With 30-Day Unplanned Hospital Readmission for Medicare Beneficiaries? Arch Phys Med Rehabil :
Kumar, Amit; Karmarkar, Amol M; Graham, James E et al. (2017) Comorbidity Indices Versus Function as Potential Predictors of 30-Day Readmission in Older Patients Following Postacute Rehabilitation. J Gerontol A Biol Sci Med Sci 72:223-228
Graham, James E; Prvu Bettger, Janet; Fisher, Steve R et al. (2017) Duration to Admission and Hospital Transfers Affect Facility Rankings from the Postacute 30-Day Rehospitalization Quality Measure. Health Serv Res 52:1024-1039
Teppala, Srinivas; Ottenbacher, Kenneth J; Eschbach, Karl et al. (2017) Variation in Functional Status After Hip Fracture: Facility and Regional Influence on Mobility and Self-Care. J Gerontol A Biol Sci Med Sci 72:1376-1382
Middleton, Addie; Graham, James E; Ottenbacher, Kenneth J (2017) Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries. Arch Phys Med Rehabil :
Middleton, Addie; Zhou, Jie; Ottenbacher, Kenneth J et al. (2017) Hospital Variation in Rates of New Institutionalizations Within 6 Months of Discharge. J Am Geriatr Soc 65:1206-1213
Howrey, Bret T; Graham, James E; Pappadis, Monique R et al. (2017) Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury. Arch Phys Med Rehabil 98:1606-1613
Graham, James E; Prvu Bettger, Janet; Middleton, Addie et al. (2017) Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation. Health Serv Res 52:1631-1646
Middleton, Addie; Lin, Yu-Li; Graham, James E et al. (2017) Outcomes Over 90-Day Episodes of Care in Medicare Fee-for-Service Beneficiaries Receiving Joint Arthroplasty. J Arthroplasty 32:2639-2647.e1

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