Spaulding Rehab and Boston University Researchers Partner to Examine the Issue
(Boston, MA) As readmissions continue to be a point of emphasis for Medicare officials and a significant healthcare quality metric that impacts care, researchers are examining ways to identify cases at risk for readmission to develop steps to mitigate readmissions. A new study co-authored by Harvard Medical School Researchers at Spaulding Rehab and the Boston University School of Public Health points to nine characteristics that “significantly increase” the odds of medically complex patients being readmitted to acute care hospitals from inpatient rehabilitation facilities (IRFs).
The study in the Journal of the American Medical Directors Association examined the variation in 30-day readmission rates among more than 117,000 medically complex patients at 682 IRFs nationwide, from 2002 to 2011. The average age of patients was 71.5.
“This study builds on our growing understanding of hospital readmissions, with particular attention to the post-acute care setting. Assessing individual hospital’s readmission rates adds accountability to the healthcare system; however, it is important to make fair comparisons between institutions that account for the differences in populations that they care for.,” said principal investigator Dr. Jeffrey Schneider, Medical Director, Burn and Trauma Rehabilitation Program at Spaulding Rehabilitation Hospital, Assistant Professor at Harvard Medical School.
This study is another in a series Dr. Schneider and researchers at Spaulding have conducted reviewing variables associated with hospital readmissions. Their work, published in journals such as PLOS One, has found that markers of functional status are powerful predictors of readmissions, which can aid in building preventative care models.
In the current study, the authors examined 16 patient and facility characteristics to identify which of those had a significant impact on readmission rates from IRFs. Nine variables were identified as significant, including: older age, male gender, higher comorbidity index, unemployed or retired status, poorer admission motor function, longer duration of impairment, larger size of IRF facility and poorer facility-wide admission motor function of all patients.
Forty-one percent of the variation in readmission rates was attributed to these nine characteristics. Further, the facilities with the highest readmission rates more commonly cared for patients at highest risk for readmission: unemployed, male patients with higher comorbidity index and poorer motor function on admission, “suggesting the need for risk adjustment if readmission rates are to be used as a quality indicator for IRFs.”
The National Quality Forum recently identified 30-day readmission rates as a quality indicator for IRFs and, as of October 1, 2016, IRF readmission rates will be published publicly as a performance measure. In addition, with the recent mandate of bundled payments for Medicare patients following joint replacement across 800 hospitals nationwide, high readmission rates from IRFs will likely result in diminishing payments to both acute care hospitals and IRFs altering the resources and abilities to adequately care for patients.
“There is increasing scrutiny of readmissions to acute care from inpatient rehabilitation facilities, such as Spaulding,” noted Dr. Schneider. “This study illustrates that a more nuanced understanding of readmissions rates is needed that accounts for specific characteristics of the population cared for at individual IRFs. It does not make sense to hold all institutions accountable to the same readmission rate standards, without accounting for the demographic and medical factors that may predispose some populations to higher readmission risk.”
Lindsay Ramey MD, Richard Goldstein PhD , Ross Zafonte DO, of the Harvard Department of PM&R at Spaulding Rehab, Colleen Ryan MD of Mass General Hospital and Lewis Kazis, professor of health law, policy and management at BUSPH, were co-authors on the study.
About Spaulding Rehabilitation Network
A member of Partners HealthCare, The Spaulding Rehabilitation Network includes Spaulding Rehabilitation Hospital, its main campus the new 132-bed facility in Charlestown, which is a national model for environmental and inclusive design as well as Spaulding Rehabilitation Hospital Cape Cod, Spaulding Hospital Cambridge and two skilled nursing facilities, as well as twenty-three outpatient sites throughout Eastern Massachusetts. Spaulding strives to continually update and improve its programs to offer patients the latest, high-quality care through its leading, expert providers. Spaulding has been awarded a Model Systems designation in three specialty areas- Brain Injury, Burn Injury Rehabilitation, and Spinal Cord Injury - by the National Institute on Disability, Independent Living and Rehabilitation Research. Spaulding is a teaching hospital of Harvard Medical School as well as the official rehabilitation hospital of the New England Revolution. Spaulding is the only rehabilitation hospital in New England continually ranked since 1995 by U.S. News and World Report in its Best Hospitals survey with a #6 ranking in 2015-2016. For more information, please visit www.spauldingrehab.org.
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