Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model

Abstract

ObjectiveTo describe the exclusion criteria and risk-adjustment model developed for the quality measure Change in Self-Care. The exclusion criteria and risk adjustment model are used to calculate Change in Self-Care scores, allowing scores to be compared across inpatient rehabilitation facilities (IRFs). DesignThis national cohort study examined admission demographic and clinical factors associated with IRF patients’ self-care change scores using standardized self-care data for Medicare patients discharged in calendar year 2017. SettingA total of 1129 IRFs in the United States. ParticipantsA total of 493,209 (N=493,209) Medicare Fee-for-Service and Medicare Advantage IRF patient stays InterventionsNot applicable. Main Outcome MeasuresSelf-care change scores using admission and discharge standardized assessment data elements from the Inpatient Rehabilitation Facility–Patient Assessment Instrument. ResultsApproximately 53% of patients were female, and 67% were between 65 and 84 years old. The final risk-adjustment model contained 93 clinically relevant risk adjusters and explained 23.1% of variance in self-care change scores. Risk adjusters that had the greatest effect on change scores and included IRF primary diagnosis group (ie, binary risk adjusters representing 13 diagnoses), prior self-care functioning, and age older than 90 years. When split by deciles of expected scores, the ratio of the average expected and observed change scores was within 2% of 1.0 across 8 groups and within 8% at the extremes, showing good predictive accuracy. ConclusionsThe risk adjustment model quantifies the relationship between IRF patients’ demographic and clinical characteristics and their self-care score changes. The exclusion criteria and model are used to risk-adjust the IRF Change in Self-Care quality measure.