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 #
5R01HD069443-03
Application #
8843498
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
2015-05-01
Budget End
2016-04-30
Support Year
3
Fiscal Year
2015
Total Cost
$306,792
Indirect Cost
$104,480
Name
University of Texas Medical Br Galveston
Department
Physical Medicine & Rehab
Type
Schools of Allied Health Profes
DUNS #
800771149
City
Galveston
State
TX
Country
United States
Zip Code
77555
Li, Chih-Ying; Karmarkar, Amol; Lin, Yu-Li et al. (2018) Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated With 30-Day Unplanned Hospital Readmission for Medicare Beneficiaries? Arch Phys Med Rehabil 99:598-602.e2
Middleton, Addie; Graham, James E; Ottenbacher, Kenneth J (2018) 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 99:1067-1076
Middleton, Addie; Downer, Brian; Haas, Allen et al. (2018) Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Skilled Nursing Facility Discharge Among Medicare Beneficiaries. J Am Med Dir Assoc 19:348-354.e4
Li, Chih-Ying; Karmarkar, Amol; Adhikari, Deepak et al. (2018) Effects of Age and Sex on Hospital Readmission in Traumatic Brain Injury. Arch Phys Med Rehabil 99:1279-1288.e1
Fisher, Steve R; Middleton, Addie; Graham, James E et al. (2018) Same But Different: FIM Summary Scores May Mask Variability in Physical Functioning Profiles. Arch Phys Med Rehabil 99:1479-1482.e1
Hong, Ickpyo; Karmarkar, Amol; Chan, Winston et al. (2018) Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation. Am J Phys Med Rehabil 97:636-645
Goodwin, James S; Li, Shuang; Middleton, Addie et al. (2018) Differences Between Skilled Nursing Facilities in Risk of Subsequent Long-Term Care Placement. J Am Geriatr Soc 66:1880-1886
Cook, Chad; Coronado, Rogelio A; Bettger, Janet Prvu et al. (2018) The association of discharge destination with 30-day rehospitalization rates among older adults receiving lumbar spinal fusion surgery. Musculoskelet Sci Pract 34:77-82
Middleton, Addie; Kuo, Yong-Fang; Graham, James E et al. (2018) Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care. J Am Med Dir Assoc 19:896-901
Middleton, Addie; Li, Shuang; Kuo, Yong-Fang et al. (2018) New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility. J Am Geriatr Soc 66:56-63

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