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.