Article

OBJECTIVE: To examine the influence of facility and aggregate patient
characteristics of inpatient rehabilitation facilities (IRFs) on
performance-based rehabilitation outcomes in a national sample of IRFs treating
Medicare beneficiaries with hip fracture. DESIGN: Secondary data analysis.
SETTING: U.S. Medicare-certified IRFs (N=983).
PARTICIPANTS: Data included
patient records of Medicare beneficiaries (N=34,364) admitted in 2009 for
rehabilitation after hip fracture. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Performance-based outcomes included mean motor function on discharge,
mean motor change (mean motor score on discharge minus mean motor score on
admission), and percentage discharged to the community. RESULTS: Higher mean
motor function on discharge was explained by aggregate characteristics of
patients with hip fracture (lower age [P=.009], lower percentage of blacks
[P<.001] and Hispanics [P<.001], higher percentage of women [P=.030], higher
motor function on admission [P<.001], longer length of stay [P<.001]) and
facility characteristics (freestanding [P<.001], rural [P<.001], for profit
[P=.048], smaller IRFs [P=.014]). The findings were similar for motor change, but
motor change was also associated with lower mean cognitive function on admission
(P=.008). Higher percentage discharged to the community was associated with
aggregate patient characteristics (lower age [P<.001], lower percentage of
Hispanics [P=.009], higher percentage of patients living with others [P<.001],
higher motor function on admission [P<.001]). No facility characteristics were
associated with the percentage discharged to the community. CONCLUSIONS:
Performance-based measurement offers health policymakers, administrators,
clinicians, and consumers a major opportunity for securing health system
improvement by benchmarking or comparing their outcomes with those of other
similar facilities. These results might serve as the basis for benchmarking and
quality-based reimbursement to IRFs for 1 impairment group: hip fracture.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS