title: Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries.
abstract: 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.
  
  
  
  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.
  
  
  
  This was a retrospective cohort study.
  
  
  
  Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013.
  
  
  
  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).
  
  
  
  Not applicable.
  
  
  
  Thirty-day unplanned rehospitalization following post-acute rehabilitation.
  
  
  
  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 %).
  
  
  
  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.
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA. jamiddle@utmb.edu.
authors.forename: Addie
authors.initials: A
authors.lastname: Middleton
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Graham
authors.affiliation: Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Division of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.affiliation: Department of Orthopaedic Surgery Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: RTI International and Rehabilitation Institute of Chicago, Chicago, IL, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D018588:Fee-for-Service Plans / Q000639:trends*; D005260:Female; D006304:Health Status; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007342:Insurance Benefits / Q000639:trends; D008297:Male; D006278:Medicare / Q000639:trends*; D009048:Motor Skills / Q000502:physiology*; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D012648:Self Care / Q000523:psychology / Q000639:trends; D019467:Subacute Care / Q000523:psychology / Q000639:trends*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: functional status; health care reform; health services research; medicare; rehabilitation