Program interruptions and short-stay transfers represent potential targets for inpatient rehabilitation care-improvement efforts

Am J Phys Med Rehabil, 2016 · DOI: 10.1097/PHM.0000000000000629 · Published: November 1, 2016

Simple Explanation

This study looks at instances where patients in inpatient rehabilitation facilities (IRF) are either temporarily transferred to another facility and then return (program interruption) or are transferred to another facility for an extended stay before completing their planned rehabilitation (short-stay transfer). The study focuses on Medicare patients recovering from stroke, traumatic brain injury (TBI), or spinal cord injury (SCI). The goal is to understand how often these interruptions and transfers occur and whether they could be reduced to improve patient care and lower healthcare costs.

Study Duration

July 1, 2012 and November 15, 2013

Participants

Medicare beneficiaries (stroke: n=71 769; TBI: n=7109; SCI: n=659)

Evidence Level

Retrospective cohort study

Key Findings

1
Program interruption rates were low: 0.9% for stroke, 0.8% for TBI, and 1.4% for SCI.
2
Short-stay transfer rates were higher: 22.3% for stroke, 21.8% for TBI, and 31.6% for SCI.
3
A portion of both program interruptions and short-stay transfers to acute care settings were identified as potentially preventable, suggesting areas for improvement in inpatient rehabilitation care.

Research Summary

This retrospective cohort study examined program interruptions and short-stay transfers among Medicare beneficiaries receiving inpatient rehabilitation following stroke, TBI, and SCI. The study found relatively low rates of program interruptions but higher rates of short-stay transfers, with variations across the three diagnostic categories. The authors suggest that reducing these interruptions and transfers could improve patient outcomes and reduce healthcare costs, aligning with the goals of current healthcare quality improvement initiatives.

Practical Implications

Policy Implications

Program interruptions and short-stay transfers may be sensible provider performance measures and could be considered as quality metrics.

Clinical Practice

Identifying modifiable risk factors for potentially undesirable outcomes will allow for targeted preventative interventions.

Future Research

Longitudinal analyses should be conducted to observe trends in program interruptions and short-stay transfers as policy and payment reforms are implemented.

Study Limitations

1
Lack of information regarding the consistency and accuracy of data entry in administrative datasets.
2
Findings may not be generalizable to individuals in the chronic phases of these conditions or to patients receiving rehabilitative care for other diagnoses.
3
Program interruptions do not always generate claims, as a patient may have briefly discharged home or to another non-Medicare covered setting, potentially underestimating rates of program interruptions.

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