Uniform Data System For Medical Rehabilitation Research Articles

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Background: The Functional Independence Measure (FIM), a part of the Uniform Data System for Medical Rehabilitation (UDSMR), examines key gradations in function from full independence to entire support using a 7-level scale to evaluate performance of essential daily living tasks (18 questions). Objectives: The objectives of this study were to develop a culturally adapted Bangla version of FIM and to test its reliability and validity in stroke patients. Materials and Methods: From March 2013 to February 2014, this observational research was conducted in the departments of physical medicine and rehabilitation and neurology at Bangabandhu Sheikh Mujib Medical University (BSMMU). Following recognized cross-cultural adaption techniques that Beaton et al., advised, the FIM was translated into Bangla. The final Bangla version of the FIM was then administered to 48 stroke patients for interviews in order to assess reliability and validity, and the same patients were re-interviewed one week later. Internal consistency (Cronbach's alpha), inter-rater reliability, and the intraclass correlation coefficient were used to evaluate dependability (ICC). Three professional physiatrists assessed the content validity, and construct validity was examined by relationship with the SF- 36's Physical Functioning Subscale (PF-10). Results: The Bangla version of the FIM was easily understood by 85-42% of respondents, whereas 10.42%(5) had trouble understanding one item and 4.17%(2) had trouble understanding two (n=48). All FIM items received responses from all participants. It was determined to contain 100% genuine material. The 35% ceiling effect was only seen in the cognitive score. For the overall FIM score, internal consistency was determined to be Cronbach's a = 0.97, and the estimated total FIM Intra-class Correlation Coefficient (ICC) was 0.95, with 0.92 for the motor subtotal and 0.96 for the cognitive subtotal. When evaluating construct validity, the motor subscale ..........

Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting.

Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through2019. In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.

Patient Functional Assessment in IRF: FIM vs CMS GG over the Last 4 Fiscal Years

<h3>Research Objectives</h3> For nearly 20 years CMS required Inpatient rehabilitation facilities (IRF) providing care to Medicare beneficiaries to complete the IRF-PAI on patients for reimbursement of services which include the FIM instrument for the assessment of patient function and outcomes. In Oct 2016 CMS changed the IRF-PAI tool to include CMS-derived GG items which also assessed patient functioning, however, the items were not required for reimbursement. In Oct 2019 CMS required submission of GG items for medical reimbursement. The purpose of this study was to examine the implications of the changes that have transpired over the past five years. The objective is to compare Reliability and Consistency between the items of the FIM and the new CMS Section GG Functional Abilities items included in the IRF-PAI instrument from Fiscal Year 2017 to 2020. <h3>Design</h3> A retrospective cohort study using data from the Uniform Data System for Medical Rehabilitation (UDSMR): cases discharged in the Fiscal Year 2017 - 2020. <h3>Setting</h3> IRFs located in the US subscribing to UDSMR; roughly 85% of all IRFs in the nation subscribe to UDSMR for benchmarking reporting. <h3>Participants</h3> All Medicare cases for patients admitted in IRFs which are subscribers of UDSMR from the fiscal year 2016 to 2020 <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Rehabilitation-related outcomes were compared; included were: average admission FIM® and average discharge FIM®, 16 GG self-care and mobility items plus bladder and bowel at admission and discharge which are included on CMS IRF-PAI instrument, Impairment conditions, CMG, LOS, discharge location. <h3>Results</h3> Forthcoming; patient outcomes as measured by the FIM and CMS GG items will be provided and trends examined over time The completion rates for items at admission and discharge by year will be analyzed including the reliability and validity of the items. Results may have policy implications in addition to possible impacts at the facility and patient level. <h3>Conclusions</h3> Presently the use of the following codes: -, ^, 7, 8, 9, 10, and 88 at admission or discharge is re-coded to a value of 1 for all GG functional items (except toilet transfer where a value of 2 is assigned) for reporting purposes per CMS. A value of 1 indicates the lowest level of function, in essence complete dependence, patient is unable to perform activity. CMS should reconsider assigning the value of 1 to patients with a code indicating the activity was not performed, as it is ultimately missing data and our analysis indicated the value of 1 may not be the most appropriate considering the discharge destination and the patient total length of stay in medical rehabilitation. Use of codes: -, ^, 7, 9, 10, 88 are missing values, where the patient's true level of functioning is unknown. This leads to uncertainty in the patient's true ability self-care and uncertainty regarding the most appropriate discharge setting to meet the patient's specific needs. Accuracy in assessment of patient's level of functioning is paramount in patient care and quality outcomes. CMS should consider removing the codes: -, ^, 7, 8, 9, 10 and 88 or advising clinicians to reserve use of the codes for the most atypical, rare exceptions. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests that relate to the research described in this poster

Capture rates of comorbidity measures at inpatient rehabilitation facilities after a stroke or brain injury.

Comorbidity indices have been used to represent the overall medical complexity of patient populations in clinical research; however, it is not known how well they capture the comorbidities of patients with a stroke or brain injury admitted to inpatient rehabilitation facilities (IRFs). To determine how well commonly used comorbidity indices capture the comorbidities of patients admitted to IRFs after a stroke or brain injury. Cross-sectional, retrospective study. IRFs nationwide. Adults from four impairment groups: (1) hemorrhagic stroke, (2) ischemic stroke, (3) nontraumatic brain injury (NTBI), and (4) traumatic brain injury (TBI). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were extracted from the Uniform Data System for Medical Rehabilitation (UDSMR) for IRF discharges from October 1, 2015 to December 31, 2017. The percentage of discharges captured by Deyo-Charlson, Elixhauser, and Centers for Medicare and Medicaid Services (CMS) tiers was determined, as was the percentage of comorbidities captured. These measures were also compared with respect to their ability to capture chronic medical complexity by examining the percentage of codes captured after removal of codes deemed to represent hospital complications or sequela of the admission diagnosis. The percentage of discharges without at least one ICD-10-CM code captured by any index ranged from 0.3%-3.8%. The percentage of comorbidities with a prevalence exceeding 1% captured by at least one index ranged from 37.1%-43.6%. Chronic comorbidities were most likely to be captured by Elixhauser (40.7%-44.4%), followed by Deyo-Charlson (7.8%-9.6%), then CMS tiers (4.5%-6.9%). Existing comorbidity measures capture most IRF discharges related to a brain injury or stroke, whereas most medical comorbidities escape representation. Several common, functionally relevant diagnoses were not captured. The use of comorbidity indices in the IRF neurologic injury population should account for the fact that these measures miss several common, important comorbidities.

Variation in Therapy Services in Inpatient Rehabilitation Facilities (IRFs) in the US

Abstract Date Presented 03/27/20 Using 2016 and 2017 Uniform Data System for Medical Rehabilitation (UDSMR) from the United States, we examined utilization of rehabilitation services among adults admitted to inpatient rehabilitation facilities and examine patient and facility characteristics associated with variation in rehabilitation services provided for stroke, fracture of the lower extremity, and major joint replacement of the lower extremity. Primary Author and Speaker: Ickpyo Hong Additional Authors and Speakers: Amol Karmarkar, Amit Kumar, Amber Armstead, Lin-Na Chou, Kenneth Ottenbacher

Characterization of inpatient rehabilitation outcomes among HIV/AIDS patients: a retrospective cohort study

ABSTRACT Survival time in HIV/AIDS patients has increased as a result of improved treatments, but many acquire functional impairments that may necessitate multidisciplinary medical rehabilitation. In the United States, inpatient rehabilitation facilities (IRF) provide this care, but outcomes are not well described in this population. We used the Uniform Data System for Medical Rehabilitation (UDSMR) database to describe 11,051 HIV/AIDS IRF patients; HIV/AIDS patients were grouped according to the following admission criteria: (1) HIV/AIDS as primary reason for admission (n = 225); (2) HIV/AIDS symptomatic comorbidity (n = 6569); and (3) HIV/AIDS asymptomatic comorbidity (n = 4257). We used standard descriptive statistics to summarize demographic, medical, rehabilitation, and discharge setting characteristics by group. When compared to patients with HIV/AIDS as a comorbidity, primary HIV/AIDS patients had worse outcomes. They made less functional change (25.1 versus 29.8 and 28.9, p < .001), went home less (73.8% versus 74.5% and 77.8%, p < .001) and to an acute care hospital more frequently (18.2% versus 13.9% and 10.1%, p < .001). These findings help to characterize the HIV/AIDS patient population who receive inpatient medical rehabilitation, which helps inform clinical care, and highlight the positive impact IRF care can make to minimize functional disability among chronic HIV/AIDS patients and possibly decrease costs of home health care.

Swallowing Status Comparison between Primary Dysphagia and Post-stroke Dysphagia in Inpatient Rehabilitation Facilities.

To examine the improvement of discharge swallowing status between patients with a primary dysphagia diagnosis and those with Post-stroke dysphagia discharged from inpatient rehabilitation facilities (IRFs). A retrospective cohort design used data from the United States Uniform Data System for Medical Rehabilitation (UDSMR) during 2016 and 2017. Ordinal logistic regression model compared the swallowing status at discharge between the two comparison groups, accounting for baseline patient and clinical characteristics. Multiple imputations with the fully conditional specification method was used to deal with the missing observations for the discharge swallowing status variable. The mean age of the sample was 71.4 years (SD = 12.8). A total of 992 patients were retrieved from the study data, including 64 patients with a primary dysphagia diagnosis and 928 patients with Post-stroke dysphagia. Adjusted ordinal logistic regression model revealed that patients with primary dysphagia had lower odds of improving their swallowing status (odds ratio [OR] 0.300: 95% Confidence Interval [CI] 0.142, 0.636) than those with Post-stroke dysphagia at discharge from IRFs. Similarly, the multiple imputations method revealed that patients with primary dysphagia had lower odds of swallowing status improvement at discharge from IRFs (OR 0.563: 95% CI 0.342, 0.925). Patients with a primary dysphagia diagnosis receiving rehabilitation services in IRFs demonstrated substantially worse swallowing status compared to those with Post-stroke dysphagia in a large national sample. This finding suggests that healthcare providers should be aware of the differences occurring in swallowing improvement across dysphagia diagnosis groups.

Variation in 30-Day Readmission Rates Among Medically Complex Patients at Inpatient Rehabilitation Facilities and Contributing Factors

ObjectiveFew studies have focused on 30-day readmission rates in inpatient rehabilitation facilities (IRFs) and factors that contribute to this. The purpose of this study was to examine the variation in 30-day readmission rates among medically complex patients at IRFs nationally and explore how patient and facility characteristics are associated with this variation. DesignRetrospective review of an administrative database. SettingIRFs throughout the United States. ParticipantsPatients from the medically complex impairment group treated at IRFs nationwide represented in the Uniform Data System for Medical Rehabilitation (UDSMR) from 2002 to 2011. MeasurementsUsing multilevel logistic regression analysis, 16 patient and facility characteristics were examined to identify and adjust for variables with a significant effect on readmission rates. Unadjusted and adjusted readmission rates were plotted by facility rank. Facilities were grouped by decile, based on readmission rates, and the mean unadjusted and adjusted rates for the lowest and highest deciles were compared to quantify the variation due to adjustment. Patient and facility characteristics for the highest and lowest deciles were compared. ResultsA total of 117,156 medically complex patients from 682 IRFs nationwide were included. Patients were 46% male and 84% white with an average age of 71.5 years. Nine of 16 characteristics were identified that significantly increased the odds of readmission, including older age, male gender, poorer admission motor function, longer duration of impairment, higher Elixhauser comorbidity index, unemployed or retired status, larger facility size, lower mean facility admission motor function, and eastern or western geographic area.The average unadjusted and adjusted readmission rates for all facilities were 15.63% and 15.86%, respectively. The unadjusted readmission rates for the lowest and highest deciles were 6.71% and 26.48%, respectively. After adjustment, this narrowed to 10.33% and 21.91%, respectively. Patient and facility characteristics accounted for 41% of the variation seen in the readmission rates for these groups.Facilities with the highest readmission rates (highest decile) more commonly cared for patients at highest risk for readmission: unemployed, male patients with higher comorbidity index and poorer motor function on admission. ConclusionThis study shows significant variation in readmission rates for medically complex patients across IRFs. However, nearly half (41.4%) of this variation was attributed to 9 patient and facility characteristics, suggesting the need for risk adjustment if readmission rates are to be used as a quality indicator for IRFs.

Evaluating Use of the Siebens Domain Management Model During Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Stroke Patients

ObjectiveTo evaluate use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home. DesignBefore and after study. SettingIR facility. ParticipantsBefore the intervention: 154 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2010; on average, they were admitted 9.1 days after receiving acute care. After the intervention: 151 patients with ischemic/hemorrhagic strokes who were admitted to an IR facility in 2012; on average they were admitted 7.3 days after receiving acute care. The comorbidity tier severity and prestroke living setting and living support appeared to be similar in both the preintervention and postintervention groups. InterventionUse of the SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home including medical/surgical issues, cognitive/emotional coping issues, physical function, and living environment/community re-entry needs. Main Outcome MeasuresUse of Functional Independence Measure (FIM) score change during IR length of stay (LOS; FIM-LOS efficiency) and rates of discharge to community/home, acute care, and long-term care (LTC) to compare 2010/preintervention data with postintervention data from 2012, along with comparison of facility data to national aggregate data from the Uniform Data System for Medical Rehabilitation (UDSMR) for both years. ResultsPreintervention 2010 FIM-LOS efficiency was 1.44 compared with a 2012 postintervention FIM-LOS efficiency of 2.24, which was significant (t = 4.3; P < .0001). Comparison of the UDSMR 2012 national FIM-LOS efficiency score (1.72) to the 2012 postintervention score of 2.24 reached significance (t = 2.6; P < .01). In addition, a significant difference was found between groups for discharge location: In the preintervention group, 57.8% were discharged to home/community, 14.9% to LTC, and 27.3% back to acute care compared with the postintervention group, in which 81.2% were discharged to home/community, 9.4% to LTC, and 9.4% back to acute care (χ2 = 8.98; P < .001). Also significant was comparison between the 2012 postintervention group and the 2012 national UDSMR data for the same 3 discharge locations (χ2 = 3.94; P < .05). Comparison of 2010 to 2012 facility data then shows a 23.4% increase in discharge to the community compared with an increase of 5.8% for the UDSMR 2010 to 2012 data, representing a community discharge rate that is 4 times greater for the 2012 facility postintervention group (χ2 = 83.596; P < .0001). ConclusionsUse of the SDMM during stroke IR may convey improvement in functional independence and is associated with an increased discharge rate to home/community and a reduction in institutionalization and acute-care transfers.

Predictors of Discharge to Acute Care after Inpatient Rehabilitation in Severely Affected Stroke Patients

This study aimed to determine the predictors of discharge to acute care after inpatient rehabilitation in severely affected stroke patients. This was a retrospective study using data from the Uniform Data System for Medical Rehabilitation (UDSMR) between 2008 and 2009. The main outcome variable was discharge location, which included discharge to acute care or discharge to the community after inpatient rehabilitation. The study sample included 223 of the most severely affected stroke patients (Case-Mix Group 0110 of Medicare reimbursement classification), of whom 86 were discharged to acute care from after the inpatient medical rehabilitation setting; 137 similarly classified stroke patients were discharged to the community after inpatient medical rehabilitation. The variables examined were Functional Independence Measure ratings, co-morbid medical conditions, and four groups of stroke-related neurologic deficits (hemiparesis, dysphagia, language deficits, and other stroke-related neurologic deficits). The groups were devised based on International Classification of Diseases, 9th Revision codes. There were no significant demographic differences between the two groups-those discharged to the acute care hospital and those discharged to the community. There was a difference in admission Functional Independence Measure ratings, whereby patients discharged to acute care were significantly lower (P < 0.05) on admission motor and cognitive function than were patients discharged to the community. When controlling for 19 groups of co-morbid medical conditions and 4 groups of stroke-related neurologic deficits, there was no significant difference between patients being discharged to an acute care hospital and those discharged to the community. In the current study, controlling for impairment (stroke), severity of condition, demographic variables, inpatient rehabilitation admission day of the week and discharge day of the week, prehospitalization living setting, prehospitalization living with (alone, family, other), payer (secondary insurance coverage), onset days, co-morbid medical conditions, and classification of stroke-related neurologic deficits, the only variable predictive of discharge to the acute care hospital from an inpatient rehabilitation facility is function at admission, mainly the admission motor Functional Independence Measure rating. If clinicians routinely assess the functional status of patients during the preadmission screening process, it may aid in identifying whether the patient is at an increased risk of being readmitted to the acute care hospital.

The uniform data system for medical rehabilitation (UDSmr) and functional health assessment

In this time of a chronic disease epidemic concurrent with an aging population, the delivery of healthcare services needs to emphasize holistic care and promotion of well-being rather than just disease care. Functional health data can be turned into quantified information that provides evidence-based knowledge for guiding clinical practice. Patients’ self-report of their functional health permits a closer realization of their actual experience and true quality of life. Functional health assessment using a biopsychosocial approach is an integral part of the delivery of health care.

*Poster 99: Impact of Duration to Admission to Inpatient Rehabilitation on Outcomes Across Multiple Impairment Categories

Objective: To identify impact of duration to admission to inpatient rehabilitation on rehabilitation-related outcomes across 5 impairment categories (stroke, brain dysfunction, spinal cord injury, orthopedic fractures, joint replacements). Design: Secondary data analysis of records obtained from the Uniform Data System for Medical Rehabilitation (UDSMR). The UDSMR is the largest nongovernmental registry comprised of data for medical rehabilitation. Setting: Inpatient rehabilitation facilities across the United States.

A Comparative Evaluation of Inpatient Rehabilitation for Older Adults With Debility, Hip Fracture, and Myopathy

Kortebein P, Granger CV, Sullivan DH. A comparative evaluation of inpatient rehabilitation for older adults with debility, hip fracture, and myopathy. Objective To compare the functional outcomes and discharge location of older adults admitted to inpatient rehabilitation for debility, hip fracture, and myopathy. Design Retrospective cohort study from 2002 to 2003 with information from the Uniform Data System for Medical Rehabilitation (UDSMR). Setting United States inpatient rehabilitation facilities subscribing to the UDSMR. Participants Patients 65 years or older (N=84.701) with primary diagnoses of debility (n=14,835), hip fracture (n=68,915), and myopathy (n=951). Interventions Not applicable. Main Outcome Measures Change in functional status, including efficiency (change in functional status divided by length of stay in days) and discharge setting. Results The efficiency of the patients with debility (1.7±2.1) was significantly lower than that of the patients with hip fracture (1.9±1.6; P<.001), but not different from the patients with myopathy (1.6±1.4; P=.3). Significantly more patients with debility (68%) were discharged home than the hip fracture and myopathy groups (66% and 65%, respectively; P<.001). Conclusions Although statistical differences exist, the functional recovery and rate of discharge home of older adult patients admitted to inpatient rehabilitation with a primary debility diagnosis are essentially the same clinically as those of patients with a diagnosis of either hip fracture or myopathy. Given these findings, and given that hip fracture and myopathy are approved medical conditions according to the Centers for Medicare and Medicaid Services 75% rule, the medical condition debility warrants consideration for inclusion as a qualifying medical diagnosis under this rule. However, further research is needed to develop relatively objective criteria for the debility diagnosis, and to identify those patients with debility who are most likely to benefit from inpatient rehabilitation.

Apparent Changes in Inpatient Rehabilitation Facility Outcomes Due to a Change in the Definition of Program Interruption

Deutsch A, Granger CV, Russell C, Heinemann AW, Ottenbacher KJ. Apparent changes in inpatient rehabilitation facility outcomes due to a change in the definition of program interruption. Objective To describe changes in inpatient rehabilitation facility (IRF) outcomes due to the program interruption definitional change, from 30 days to 3 days, in 2002. Design Secondary data analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database. Setting Four hundred eleven IRFs that submitted data to the UDSMR database in each of the years 1998 through 2003. Participants Patient assessment data for 772,584 Medicare fee-for-service beneficiaries. Interventions None. Main Outcome Measures The number of IRF patient discharges, percent of IRF patients discharged to the community, percent of IRF patients discharged to acute care, percent of IRF patients with program interruptions, percent of IRF inpatient deaths, and average IRF length of stay (LOS). Results IRF outcomes appeared to change because of the program interruption redefinition, with changes varying by impairment group. The largest changes due to the redefinition occurred for patients with traumatic spinal cord injury, including the largest percentage increase in patients (5.16%), the largest decrease in program interruptions (5.14%), the largest increase in acute care discharges (5.04%), and the largest mean decrease in LOS (1.27d). Community discharge showed the largest decrease for patients with Guillain-Barré syndrome (4.03%). Conclusion The change in the definition of program interruptions creates the appearance of changes in IRF performance and is important to consider when comparing the preprospective payment system (PPS) and PPS assessment data.

Outcomes of Inpatient Rehabilitation for Older Adults with Debility

To determine the functional outcomes and discharge setting of older patients receiving inpatient rehabilitation for debility (ICD-9-CM, 799.3). Retrospective cohort study of 63,171 individuals >or= 65 yrs old with a primary (23%) or comorbid (77%) debility diagnosis from the Uniform Data System for Medical Rehabilitation (UDSMR) database for 2002-2003. Patients with a primary diagnosis of debility (PDD) had a lower mean rehabilitation efficiency score (functional change per day) as compared with the rest of the subjects (1.7 vs. 1.9, P<0.001), including those with a Centers for Medicare & Medicaid Services (CMS) 75% rule primary diagnosis (1.8, P<0.001). The PDD group was less likely to be discharged home (68% vs. 73%, P<0.001) and more likely to be discharged to a hospital (13% vs. 11%, P<0.001). From a clinical perspective, the functional recovery of older patients with debility is essentially the same, regardless of whether this is a primary or comorbid diagnosis. Their functional improvement is also comparable with that reported for other CMS 75% rule diagnoses, although the debility patients are less likely to be discharged home. More than 10% of these patients were discharged to acute hospital settings. Further research is warranted to identify the most appropriate rehabilitation setting for patients with debility.

Poster 50: Outcomes of Inpatient Rehabilitation for Deconditioning

Objectives: To collect information on the outcomes of older adults who have received inpatient rehabilitation for deconditioning and to investigate whether the diagnosis of deconditioning (ICD-9 code 799.3) might be included as a criterion medical condition for classification as an inpatient rehabilitation facility under the Center for Medicare and Medicaid Services 75% rule. Design: Retrospective cohort study of patients included in the Uniform Data System for Medical Rehabilitation (UDSmr) database for 2002 to 2003. Setting: Inpatient rehabilitation facilities in the United States subscribing to UDSmr. Participants: 63,171 individuals ≥65 years old (62% women, 98% previously living independently) with a primary (23%) or secondary (77%) diagnosis of deconditioning. Interventions: Not applicable. Main Outcome Measures: FIM efficiency (change in FIM score/length of stay [in days]), FIM efficiency subscores for locomotion and self-care, and discharge settings. Results: Individuals with a primary diagnosis of deconditioning (PDD) had a significantly lower FIM efficiency compared with the remaining subjects (1.78 vs 1.90, P<.001), or to the subgroup of subjects with a 75% rule primary diagnosis (1.67 vs 1.88, P<.001). The individuals with PDD also had lower FIM efficiency subscores, were less likely to be discharged to the community (73% vs 76%, P<.001) or home (68% vs 73%, P<.001), and were more likely to be discharged to a hospital (7% vs 4%, P<.001). Conclusions: Older individuals with PDD appear to recover at a slower rate than those with a secondary diagnosis of deconditioning, and are somewhat less likely to return home. The clinical significance of these findings is uncertain, but further investigation is warranted.

The Uniform Data System for Medical Rehabilitation Report

This is the third annual report describing patients discharged from subacute rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation (UDSmr). The analysis included 39,562 complete records of first admission cases discharged alive from 180 facilities in 1999. Sixty-five percent of the patients were women, and most patients (91%) were white. Sixty-two percent of the patients were 75 yr of age or older. Before the impairment onset, 55% lived with at least one other person. The average total FIM (motor and cognitive) score change for all patients was 21.1 points, and when stratified by rehabilitation impairment group, average scores ranged from 18.3 for patients with pulmonary conditions to 25.3 for patients with a joint replacement. The percentage of patients discharged to a community-based setting ranged from 67% for patients with stroke to 94% for patients with a joint replacement. These data show that patients receiving care in subacute rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

Functional gains and therapy intensity during subacute rehabilitation: A study of 20 facilities

Chen CC, Heinemann AW, Granger CV, Linn RT. Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities. Arch Phys Med Rehabil 2002;83:1514-23. Objectives: To document patient, program characteristics, and therapy service provision in subacute rehabilitation across 3 types of facilities that provide subacute rehabilitation, to examine the determinants of therapy intensity, and to evaluate the contribution of rehabilitation services to functional gains. Design: A retrospective study linking administrative billing data and patients' functional assessment records. Setting: Twenty facilities part of the Uniform Data System for Medical Rehabilitation (UDSMR) subacute database Participants: A total of 1976 billing records of patients with stroke, orthopedic, and debility impairments, discharged in 1996 and 1997, were retrieved and linked with the FIM™ instrument ratings from UDSMR subacute database. Interventions: Not applicable. Main Outcomes Measures: Total therapy intensity and Rasch-transformed FIM domain gains (ie, gains in self-care, mobility, cognition). Results: Therapy intensity was mostly determined by impairment and facility type, although variances explained by the predictors were small. Patients in all 3 impairment groups made functional gains; gains were related weakly, although significantly, to therapy intensity and rehabilitation duration after controlling for other variables. Conclusions: The provision of rehabilitation therapies varied across facilities. Skilled nursing facilities with subacute rehabilitation units tended to provide more therapies than subacute units in acute or rehabilitation hospitals. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Predicting follow-up living setting in patients with stroke

Smith PM, Ottenbacher KJ, Cranley M, Dittmar SS, Illig SB, Granger CV. Predicting follow-up living setting in patients with stroke. Arch Phys Med Rehabil 2002;83:764-70. Objective: To examine living setting at 3- to 6-month follow-up for inpatients with functional impairments discharged from medical rehabilitation. Design: Retrospective performed by using information from the Uniform Data System for Medical Rehabilitation (UDSMR) representing medical rehabilitation patients across the United States. Setting: National survey data. Participants: Information submitted in 1997 and 1998 to the UDSMR by 167 facilities from 40 states was examined. A total of 9587 patient records were included in the final sample. The mean age ± standard deviation was 70.2±12.4 years. The sample included 51.6% women and was comprised of 77.5% non-Hispanic white patients, with an average length of stay of 22.3±4.6 days. Interventions: Not applicable. Main Outcome Measure: Living setting (home vs not at home) at 3- to 6-month follow-up. Results: A discriminant function training model including 8 statistically significant variables correctly classified 85.1% of the patients (n=8149). The total FIM™ instrument score, patient age, function-related group, and marital status were found to be useful classification variables. Wilks λ for the model was.924 (X2=1031.49, P<.000). The area under the receiver operating characteristics curve was.85. Conclusion: The association among functional abilities, demographic characteristics, and follow-up living setting in patients with stroke is complex. Functional variables can be used to help predict follow-up living setting. These variables change based on patient severity level. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Characteristics of persons rehospitalized after stroke rehabilitation

Ottenbacher KJ, Smith PM, Illig SB, Fiedler RG, Gonzales V, Granger CV. Characteristics of persons rehospitalized after stroke rehabilitation. Arch Phys Med Rehabil 2001;82:1367-74. Objective: To develop classification models for risk of hospital readmission 80 to 180 days after discharge based the demographic and functional characteristics of persons discharged from acute inpatient rehabilitation after stroke. Design: Retrospective, using information from US facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSMR). Setting: Information submitted to the UDSMR from 1994 through 1996 by 167 hospital and rehabilitation facilities from 40 states was examined. Participants: A total of 15,992 records of patients (mean age ± standard deviation, 70.97 ± 12.19yr) with a diagnosis of stroke were included in the final sample. The sample included 52.7% women and was 80% non-Hispanic white with an average length of stay (LOS) of 25.31 ± 14.72 days. Interventions: Not applicable. Main Outcome Measures: Six subscales of the FIM™ instrument (self-care, spinchter control, transfers, locomotion, communication, social cognition), total FIM, and other predictor variables for regression analysis (gender, age, ethnicity, marital status, prehospital living setting, LOS, primary payer source, level of function-related group). Results: A logistic regression model included the following statistically significant variables (p < .05): ethnicity, sphincter control, self-care ability, gender, and LOS. The greatest variability occurred among men. Exactly 18.1% of non-Hispanic white men and 17.9% of African-American men were rehospitalized. In contrast, only 10.1% of Hispanic men and 11.4% of Asian men were rehospitalized. The odds of rehospitalization were lowest for Hispanic men. Conclusion: As prospective payment systems are introduced for postacute care, it is important that the relationship among functional abilities, demographic characteristics, and incidence of hospital readmission following medical rehabilitation be examined. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation