Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation

Laura Coots Daras*, Melvin J. Ingber, Jessica Carichner, Daniel Barch, Anne Deutsch, Laura M. Smith, Alan Levitt, Joel Andress

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs). Design: Observational design. Setting: Inpatient rehabilitation facilities. Participants: Medicare fee-for-service beneficiaries (N=567,850 patient-stays). Interventions: Not applicable. Main Outcome Measures: The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission. Results: The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was.70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis. Conclusions: Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates.

Original languageEnglish (US)
Pages (from-to)1049-1059
Number of pages11
JournalArchives of physical medicine and rehabilitation
Volume99
Issue number6
DOIs
StatePublished - Jun 2018

Keywords

  • Inpatient rehabilitation
  • Medicare
  • Patient readmission
  • Rehabilitation
  • Subacute care

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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