Do Medicare Inpatient Rehabilitation Facility Patients' Self-Care and Mobility Outcomes Vary by Dual Eligibility Status, Race and Ethnicity, Rural Residence, Socioeconomic Status, and Living Alone?

Abstract

To examine whether inpatient rehabilitation facility (IRF) patients' risk-adjusted functional outcomes varied with five social drivers of health: Medicare-Medicaid dual eligibility status, race and ethnicity, rural residence, socioeconomic status (SES), and living alone. This cohort study examined unadjusted and adjusted mobility and self-care change scores during IRF stays for 428,710 Medicare patients with and without social drivers of health. Regression models isolated the mean marginal effect of each of the five social factors on mobility and self-care change scores after adjusting for covariates. Patients with full dual status had slightly lower risk-adjusted mobility and self-care improvement (-4.5% and -3.3%, respectively) compared to patients without dual status. Patients who identified as Black, Asian and Native Hawaiian had self-care marginal effects that were slightly lower (-4.8%, -4.1% and -3.7%, respectively) than patients who were White. Patients living in lower SES neighborhoods and patients who lived alone had slightly higher mobility and self-care improvement scores. Risk-adjusted marginal differences in improvement scores for patients with and without these social factors were small and did not meet the meaningfully different criteria. Overall, IRF patients' risk-adjusted functional outcomes did not vary meaningfully by dual eligibility status, race or ethnicity, rural residence, SES or living alone.