Brian Downer1, Timothy A Reistetter2, Yong-Fang Kuo3, Shuang Li4, Amol Karmarkar5, Ickpyo Hong6, James S Goodwin7, Kenneth J Ottenbacher8. 1. University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston, TX; University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX. Electronic address: brdowner@utmb.edu. 2. University of Texas Health Science Center at San Antonio, School of Health Professions, Department of Occupational Therapy, San Antonio, TX. 3. University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX; University of Texas Medical Branch, Preventive Medicine and Population Health, Office of Biostatistics, Galveston, TX. 4. University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX. 5. Virginia Commonwealth University, School of Medicine, Department of Physical Medicine and Rehabilitation, Richmond, VA. 6. Yonsei University, College of Health Sciences, Department of Occupational Therapy, Seoul, Korea. 7. University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX; University of Texas Medical Branch, Department of Internal Medicine, Division of Geriatrics, Galveston, TX. 8. University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston, TX; University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX.
Abstract
OBJECTIVE: To determine whether patients with a total or partial hip replacement admitted to a skilled nursing facility (SNF) after the improvement in function quality measure was added to Nursing Home Compare in July 2016 have greater physical recovery than patients admitted before July 2016. DESIGN: Pre (January 1, 2015-June 30, 2016) vs post (July 1, 2016-December 31, 2017) design. SETTING: Skilled nursing facilities (n=12,829). PARTICIPANTS: Medicare fee-for-service beneficiaries (N=106,832) discharged from acute hospitals to SNF after hip replacement between January 1, 2015 and December 31, 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 5- and 14-day minimum data set assessments were used to calculate total scores for the quality measure, self-care, mobility, and balance. We calculated the average adjusted change per 10 days and any improvement between the 5- and 14-day assessments. RESULTS: The average adjusted change per 10 days for the quality measure total score for patients admitted before July 2016 and after July 2016 was 1.00 points (standard error, 0010) and 1.06 points (standard error, 0.010), respectively (P<.01). This was a relative increase of 6.0%. Among patients admitted to a SNF before July 2016, 44.4% (standard error, 0.06) had any improvement in the quality measure total score compared with 45.5% (standard error, 0.23) of patients admitted after July 2016 (P<.01). This was a relative increase of 2.5%. The adjusted change per 10 days and percentage of patients who had any improvement in the total scores for self-care, mobility, and balance were all significantly higher after July 2016. CONCLUSIONS: Patients admitted to a SNF after a hip replacement after July 2016 had greater physical recovery than patients admitted before the improvement in function quality measure was added to Nursing Home Compare.
OBJECTIVE: To determine whether patients with a total or partial hip replacement admitted to a skilled nursing facility (SNF) after the improvement in function quality measure was added to Nursing Home Compare in July 2016 have greater physical recovery than patients admitted before July 2016. DESIGN: Pre (January 1, 2015-June 30, 2016) vs post (July 1, 2016-December 31, 2017) design. SETTING: Skilled nursing facilities (n=12,829). PARTICIPANTS: Medicare fee-for-service beneficiaries (N=106,832) discharged from acute hospitals to SNF after hip replacement between January 1, 2015 and December 31, 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 5- and 14-day minimum data set assessments were used to calculate total scores for the quality measure, self-care, mobility, and balance. We calculated the average adjusted change per 10 days and any improvement between the 5- and 14-day assessments. RESULTS: The average adjusted change per 10 days for the quality measure total score for patients admitted before July 2016 and after July 2016 was 1.00 points (standard error, 0010) and 1.06 points (standard error, 0.010), respectively (P<.01). This was a relative increase of 6.0%. Among patients admitted to a SNF before July 2016, 44.4% (standard error, 0.06) had any improvement in the quality measure total score compared with 45.5% (standard error, 0.23) of patients admitted after July 2016 (P<.01). This was a relative increase of 2.5%. The adjusted change per 10 days and percentage of patients who had any improvement in the total scores for self-care, mobility, and balance were all significantly higher after July 2016. CONCLUSIONS: Patients admitted to a SNF after a hip replacement after July 2016 had greater physical recovery than patients admitted before the improvement in function quality measure was added to Nursing Home Compare.
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