Chih-Ying Li1, Amol Karmarkar2, Yu-Li Lin3, Yong-Fang Kuo3, Kenneth J Ottenbacher2, James E Graham2. 1. Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX. Electronic address: chili@utmb.edu. 2. Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX. 3. Office of Biostatistics, Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, TX.
Abstract
OBJECTIVE: To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs). DESIGN: Study using 100% Medicare claims data, covering 269,306 discharges from 1094 IRFs between October 2010 and September 2011. SETTING: IRFs with at least 30 discharges. PARTICIPANTS: A total number of 1094 IRFs (N=269,306) serving Medicare fee-for-service beneficiaries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Risk-standardized readmission rate (RSRR) for 30-day hospital readmission. RESULTS: Profit status was the only provider-level IRF characteristic significantly associated with unplanned readmissions. For-profit IRFs had a significantly higher RSRR (13.26±0.51) than did nonprofit IRFs (13.15±0.47) (P<.001). After controlling for all other facility characteristics (except for accreditation status because of its collinearity with facility type), for-profit IRFs had a 0.1% point higher RSRR than did nonprofit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (type III test, P=.005 for both). CONCLUSIONS: Our findings support the inclusion of profit status on the IRF Compare website (a platform including IRF comparators to indicate quality of services). For-profit IRFs had a higher RSRR than did nonprofit IRFs for Medicare beneficiaries. The South had a higher RSRR than did other regions. The RSRR difference between for-profit and nonprofit IRFs could be due to the combined effects of organizational and regional factors.
OBJECTIVE: To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs). DESIGN: Study using 100% Medicare claims data, covering 269,306 discharges from 1094 IRFs between October 2010 and September 2011. SETTING: IRFs with at least 30 discharges. PARTICIPANTS: A total number of 1094 IRFs (N=269,306) serving Medicare fee-for-service beneficiaries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Risk-standardized readmission rate (RSRR) for 30-day hospital readmission. RESULTS: Profit status was the only provider-level IRF characteristic significantly associated with unplanned readmissions. For-profit IRFs had a significantly higher RSRR (13.26±0.51) than did nonprofit IRFs (13.15±0.47) (P<.001). After controlling for all other facility characteristics (except for accreditation status because of its collinearity with facility type), for-profit IRFs had a 0.1% point higher RSRR than did nonprofit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (type III test, P=.005 for both). CONCLUSIONS: Our findings support the inclusion of profit status on the IRF Compare website (a platform including IRF comparators to indicate quality of services). For-profit IRFs had a higher RSRR than did nonprofit IRFs for Medicare beneficiaries. The South had a higher RSRR than did other regions. The RSRR difference between for-profit and nonprofit IRFs could be due to the combined effects of organizational and regional factors.
Authors: Leora I Horwitz; Susannah M Bernheim; Joseph S Ross; Jeph Herrin; Jacqueline N Grady; Harlan M Krumholz; Elizabeth E Drye; Zhenqiu Lin Journal: Med Care Date: 2017-05 Impact factor: 2.983
Authors: James E Graham; Janet Prvu Bettger; Steve R Fisher; Amol M Karmarkar; Amit Kumar; Kenneth J Ottenbacher Journal: Health Serv Res Date: 2016-06-28 Impact factor: 3.402
Authors: Karthikeyan E Ponnusamy; Zan Naseer; Mostafa H El Dafrawy; Louis Okafor; Clayton Alexander; Robert S Sterling; Harpal S Khanuja; Richard L Skolasky Journal: J Bone Joint Surg Am Date: 2017-06-07 Impact factor: 5.284
Authors: Momotazur Rahman; Andrew D Foster; David C Grabowski; Jacqueline S Zinn; Vincent Mor Journal: Health Serv Res Date: 2013-10-17 Impact factor: 3.402
Authors: Vikram R Comondore; P J Devereaux; Qi Zhou; Samuel B Stone; Jason W Busse; Nikila C Ravindran; Karen E Burns; Ted Haines; Bernadette Stringer; Deborah J Cook; Stephen D Walter; Terrence Sullivan; Otavio Berwanger; Mohit Bhandari; Sarfaraz Banglawala; John N Lavis; Brad Petrisor; Holger Schünemann; Katie Walsh; Neera Bhatnagar; Gordon H Guyatt Journal: BMJ Date: 2009-08-04