title: Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure.
abstract: To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016.
  
  
  
  Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability.
  
  
  
  IRFs.
  
  
  
  Medicare FFS patients aged ≥21 years (N=4769).
  
  
  
  Not applicable.
  
  
  
  Facility-level discharge self-care quality measure performance score.
  
  
  
  A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%-100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91.
  
  
  
  The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs.
authors.affiliation: RTI International, Chicago, IL. Electronic address: pardasaney@rti.org.
authors.forename: Poonam K
authors.initials: PK
authors.lastname: Pardasaney
authors.affiliation: RTI International, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: RTI International, Research Triangle Park, NC.
authors.forename: Jeniffer
authors.initials: J
authors.lastname: Iriondo-Perez
authors.affiliation: RTI International, Washington (DC).
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Ingber
authors.affiliation: Centers for Medicare & Medicaid Services, Baltimore, MD.
authors.forename: Tara
authors.initials: T
authors.lastname: McMullen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D011594:Psychometrics; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000592:standards*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
keywords: Inpatients; Outcome assessment (health care); Quality of health care; Rehabilitation; Self care