Functional Impairment and Hospital Readmission in Medicare Seniors

Greysen, S. Ryan; Cenzer, Irena Stijacic; Auerbach, Andrew D.; Covinsky, Kenneth E.

doi:10.1001/jamainternmed.2014.7756

Cited by 224 publications

(222 citation statements)

References 29 publications

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“…19,23 By employing three condition-specific models as opposed to one all-cause readmission model, our results enable us to compare and contrast the effects of these patient characteristics on readmission risk by condition. The results illustrate that the additional predictive effects these disability and social determinants of health have on readmission risk varies by the condition for index admission.…”

Section: Discussionmentioning

confidence: 99%

“…7 However, an increasing body of literature reveals that patient disability and social determinants of health impact readmission risk and vary across hospital populations, contributing to higher readmission penalties for safety-net hospitals-and generating increasing interest in studying risk adjustment for sociodemographic factors. 1,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] To provide a better understanding of the extent to which the addition of patient disability and social determinants of health would impact the current risk adjustment models used by CMS, the objective of our study was to assess how measures of disability and social determinants of health were associated Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3869-x) contains supplementary material, which is available to authorized users.…”

Section: T He Centers For Medicare and Medicaid Services (Cms)mentioning

confidence: 99%

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The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

et al. 2016

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BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social d e t e r m i n an t s o f h ea l t h o n c o n d i t i o n-s p e c i f i c readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. M A I N M E A S U R E S : O u t c o m e s m e a s u r e d w e r e readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Codepercentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. KEY RESULTS: For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66,) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292)

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Section: Discussionmentioning

confidence: 99%

Section: T He Centers For Medicare and Medicaid Services (Cms)mentioning

confidence: 99%

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

et al. 2016

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“…5 Previous studies examining rehospitalization and post-acute inpatient rehabilitation have focused on predictors other than the functional domains identified by the IMPACT Act and outcomes other than post-discharge 30-day unplanned rehospitalization. 9,11,[21][22][23][24][25][26] Unplanned rehospitalizations have the potential for improvement 7,27 and are the focus of the current quality improvement policies being developed by CMS and the National Quality Forum. 28 In our national sample of community-dwelling adults who were discharged from post-acute rehabilitation, the overall unadjusted 30-day unplanned rehospitalization rate was 12.0 %.…”

Section: Discussionmentioning

confidence: 99%

“…8 Functional status is a key post-acute outcome and is associated with risk of rehospitalization. [9][10][11][12] However, the relationship between the functional domains identified in the IMPACT Act (self-care, mobility, and cognition) and rehospitalization following post-acute care have not been investigated in a large national sample. 13 The three functional domains listed in the IMPACT Act are largely discipline-specific (mobility -physical therapy; self-care -occupational therapy; cognition -occupational and/or speech/language therapy) when measured in postacute inpatient rehabilitation settings.…”

Section: Introductionmentioning

confidence: 99%

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

et al. 2016

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BACKGROUND:The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. OBJECTIVE: To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. DESIGN: This was a retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013. PARTICIPANTS: Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012-2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). INTERVENTIONS: Not applicable. MAIN MEASURES: Thirty-day unplanned rehospitalization following post-acute rehabilitation. KEY RESULTS: The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42-1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27-1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09-1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3-17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3-8.8 %) for those independent for both (n = 74,641; 29.6 %). CONCLUSIONS:The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

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“…First, systems for accurately and reliably identifying patient factors that could substantially affect ability to rehabilitate (eg delirium) must be developed or enhanced. [52][53][54] Second, more formal evaluation of the ability of patients and their caregivers to succeed at home is needed. [55][56][57][58][59][60] Patients and caregivers may not understand their home needs without first "testing" the experience prior to discharge.…”

Section: Opportunities For Hospitalists Improve Hospital and Transitimentioning

confidence: 99%

Post–Acute Care Reform: Implications and Opportunities for Hospitalists

Burke

Cumbler

Coleman³

et al. 2017

Journal of Hospital Medicine

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Nearly all practicing hospitalists have firsthand experience discharging patients to post–acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.

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Functional Impairment and Hospital Readmission in Medicare Seniors

Cited by 224 publications

References 29 publications

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries

Post–Acute Care Reform: Implications and Opportunities for Hospitalists

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