title: Predictors of 30-Day Readmission Following Inpatient Rehabilitation for Patients at High Risk for Hospital Readmission.
abstract: BACKGROUND
  The proposed Centers for Medicare & Medicaid Services (CMS) 30-day readmission risk standardization models for inpatient rehabilitation facilities establish readmission risk for patients at admission based on a limited set of core variables. Considering functional recovery during the rehabilitation stay may help clinicians further stratify patient groups at high risk for hospital readmission.
  
  
  OBJECTIVE
  The purpose of this study was to identify variables in the full administrative medical record, particularly in regard to physical function, that could help clinicians further discriminate between patients who are and are not likely to be readmitted to an acute care hospital within 30 days of rehabilitation discharge.
  
  
  METHODS
  This study used an observational cohort with a 30-day follow-up of Medicare patients who were deconditioned and had medically complex diagnoses and who were receiving postacute inpatient rehabilitation in 2010 to 2011.
  
  
  METHODS
  Patients in the highest risk quartile for readmission (N=25,908) were selected based on the CMS risk prediction model. Hierarchical generalized linear models were built to compare the relative effectiveness of motor functional status ratings in predicting 30-day readmission. Classification and regression tree analysis was used to create a hierarchical order among predictors based on variable importance in classifying patients based on readmission status.
  
  
  RESULTS
  Approximately 34% of patients in the high-risk quartile were readmitted within 30 days. Functional outcomes and rehabilitation length of stay were the best predictors of 30-day rehospitalization. A 3-variable algorithm classified 4 clinical subgroups with readmission probabilities ranging from 28% to 75%.
  
  
  CONCLUSIONS
  Although planned readmissions were accounted for in the outcome, potentially preventable readmissions were not distinguished from unpreventable readmissions.
  
  
  CONCLUSIONS
  For older patients who are deconditioned and have medically complex diagnoses admitted to postacute inpatient rehabilitation, information on functional status measures that are easily monitored by health care providers may improve plans for care transition and reduce the risk of hospital readmission.
authors.affiliation: S.R. Fisher, PT, PhD, Department of Physical Therapy, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0460 (USA). stfisher@utmb.edu.
authors.forename: Steve R
authors.initials: SR
authors.lastname: Fisher
authors.affiliation: J.E. Graham, DC, PhD, Division of Rehabilitation Sciences, The University of Texas Medical Branch.
authors.forename: James E
authors.initials: JE
authors.lastname: Graham
authors.affiliation: S. Krishnan, PT, PhD, Division of Rehabilitation Sciences, The University of Texas Medical Branch.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Krishnan
authors.affiliation: K.J. Ottenbacher, OTR, PhD, Division of Rehabilitation Sciences, The University of Texas Medical Branch.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006302:Health Services Research; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States