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Program Interruptions and Short-Stay Transfers Represent Potential Targets for Inpatient Rehabilitation Care-Improvement Efforts

Middleton, Addie PhD, DPT; Graham, James E. PhD, DC; Krishnan, Shilpa PhD, PT; Ottenbacher, Kenneth J. PhD, OTR

American Journal of Physical Medicine & Rehabilitation: November 2016 - Volume 95 - Issue 11 - p 850–861
doi: 10.1097/PHM.0000000000000629
Original Research Articles
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Objective The objective of this work was to present comprehensive descriptive summaries of program interruptions and short-stay transfers among Medicare fee-for-service beneficiaries receiving inpatient rehabilitation after stroke, traumatic brain injury (TBI), and traumatic spinal cord injury (SCI).

Design Retrospective cohort study of Medicare beneficiaries with any of the 3 conditions of interest who were admitted to inpatient rehabilitation directly from an acute hospital between July 1, 2012, and November 15, 2013.

Results In the final sample (stroke, n = 71 769; TBI, n = 7109; SCI, n = 659), program interruption rates were 0.9% (stroke), 0.8% (TBI), and 1.4% (SCI). Short-stay transfer rates were 22.3% (stroke), 21.8% (TBI), and 31.6% (SCI); 14.7% of short-stay transfers and 12.3% of interruptions resulting in a return to acute care were identified as potentially preventable among those with stroke; 10.2% of transfers and 11.7% of interruptions among those with TBI, and 3.8% of transfers and 11.1% of interruptions among those with SCI.

Conclusions Broad health care policies aimed at improving quality and reducing costs are currently being implemented. Reducing program interruptions and short-stay transfers during inpatient rehabilitative care represents a potential target for care-improvement efforts. Future research focused on identifying modifiable risk factors for potentially undesirable outcomes will allow for targeted preventative interventions.

Supplemental digital content is available in the text.

From the Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas.

All correspondence and requests for reprints should be addressed to: Addie Middleton, PhD, DPT, University of Texas Medical Branch, 301 University Blvd, Galveston, TX.

The study was supported by the National Institutes of Health (R24-HD065702, R01-HD069443, and 5K12HD055929-09, PI, K. Ottenbacher) and the National Institute for Disability, Independent Living, and Rehabilitation Research (H133G140127, PI, K. Ottenbacher).

The authors have no commercial interest relevant to the subject of the manuscript, nor any other conflicts of interest to report. The information included in the manuscript has not been submitted to any other source for publication or presentation.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

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