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Titre : | Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model (2022) |
Auteurs : | Anne Deutsch ; Tara McMullen ; Molly Vaughan ; Lauren Palmer ; Sophia Kwon ; Melvin J. Ingber |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 103, n° 6, 2022) |
Article en page(s) : | p. 1085-1095 |
Note générale : | https://doi.org/10.1016/j.apmr.2022.02.009 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Centres de rééducation et de réadaptation ; Résultat thérapeutique |
Résumé : |
Objective
To describe the exclusion criteria and risk-adjustment model developed for the quality measure Change in Self-Care. The exclusion criteria and risk adjustment model are used to calculate Change in Self-Care scores, allowing scores to be compared across inpatient rehabilitation facilities (IRFs). Design This national cohort study examined admission demographic and clinical factors associated with IRF patients self-care change scores using standardized self-care data for Medicare patients discharged in calendar year 2017. Setting A total of 1129 IRFs in the United States. Participants A total of 493,209 (N=493,209) Medicare Fee-for-Service and Medicare Advantage IRF patient stays Interventions Not applicable. Main Outcome Measures Self-care change scores using admission and discharge standardized assessment data elements from the Inpatient Rehabilitation FacilityPatient Assessment Instrument. Results Approximately 53% of patients were female, and 67% were between 65 and 84 years old. The final risk-adjustment model contained 93 clinically relevant risk adjusters and explained 23.1% of variance in self-care change scores. Risk adjusters that had the greatest effect on change scores and included IRF primary diagnosis group (ie, binary risk adjusters representing 13 diagnoses), prior self-care functioning, and age older than 90 years. When split by deciles of expected scores, the ratio of the average expected and observed change scores was within 2% of 1.0 across 8 groups and within 8% at the extremes, showing good predictive accuracy. Conclusions The risk adjustment model quantifies the relationship between IRF patients demographic and clinical characteristics and their self-care score changes. The exclusion criteria and model are used to risk-adjust the IRF Change in Self-Care quality measure. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.come/science/article/pii/S0003999322002647#! |