Concurrent Validation of the Inpatient Rehabilitation Facility Patient Assessment Instrument Version 1.4; Sections GG, B, and C

Harmon, Erin Y.; Sonagere, Matthew B.

doi:10.1016/j.apmr.2023.07.009

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…Finally, the self-care and mobility outcomes used in this study are cross-setting measures of function that were implemented in OASIS in 2019 and have been validated in other postacute settings. 37 , 58 , 59 While MA patients were less likely to improve in function compared with TM, the extent to which a dichotomous outcome of functional improvement reflects differences in quality of life or independence is unknown.…”

Section: Discussionmentioning

confidence: 99%

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Prusynski,

D’Alonzo,

Johnson

et al. 2024

JAMA Health Forum

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ImportancePrivate Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking.ObjectiveTo examine differences in home health service intensity and patient outcomes between MA and TM.Design, Setting, and ParticipantsThis cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024ExposureTM vs MA plan.Main Outcomes and MeasuresHome health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health.ResultsOf 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, −1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08).Conclusions and RelevanceThe results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.

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Section: Discussionmentioning

confidence: 99%

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Prusynski,

D’Alonzo,

Johnson

et al. 2024

JAMA Health Forum

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Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke

Mangone,

Shahriary,

Bosch

2024

PM&R

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BackgroundThis study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility‐Patient Assessment Instrument (IRF‐PAI), and community discharge from IRF.ObjectivesAim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF‐PAI self‐care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF‐PAI admission functional measures to predict community discharge from IRF after stroke.DesignRetrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019.SettingAcademic hospital‐based IRF.ParticipantsFive hundred forty‐four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hours of IRF admission.InterventionsNot applicable.Main Outcome MeasuresAdmission IRF‐PAI self‐care and mobility scores and discharge status from IRF.ResultsOf the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF‐PAI admission self‐care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF‐PAI admission mobility score. IRF admission self‐care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03–1.17; OR = 1.10, CI: 1.03–1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47–1.04) from IRF.ConclusionsIRF‐PAI self‐care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF‐PAI self‐care and mobility measures each predict community discharge.

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Assessing Clinically Important Differences During Rehabilitation for Stroke: A Pilot Study Evaluating Anchor and Distribution Derived Estimates of Physical Function Change in Classically Summed and Rasch Models of Section GG of the Inpatient Rehabilitation Facility Patient Assessment Instrument

Harmon,

Niyirora,

Teale

et al. 2024

Archives of Physical Medicine and Rehabilitation

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Concurrent Validation of the Inpatient Rehabilitation Facility Patient Assessment Instrument Version 1.4; Sections GG, B, and C

Cited by 3 publications

References 15 publications

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke

Assessing Clinically Important Differences During Rehabilitation for Stroke: A Pilot Study Evaluating Anchor and Distribution Derived Estimates of Physical Function Change in Classically Summed and Rasch Models of Section GG of the Inpatient Rehabilitation Facility Patient Assessment Instrument

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