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- Title
Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation.
- Authors
Graham, James E.; Prvu Bettger, Janet; Middleton, Addie; Spratt, Heidi; Sharma, Gulshan; Ottenbacher, Kenneth J.
- Abstract
<bold>Objective: </bold>To examine the effects of facility-level acute-postacute continuity on probability of community discharge and 30-day rehospitalization following inpatient rehabilitation.<bold>Data Sources: </bold>We used national Medicare enrollment, claims, and assessment data to study 541,097 patients discharged from 1,156 inpatient rehabilitation facilities (IRFs) in 2010-2011.<bold>Study Design: </bold>We calculated facility-level continuity as the percentages of an IRF's patients admitted from each contributing acute care hospital. Patients were categorized into three groups: low continuity (<26 percent from same hospital that discharged the patient), medium continuity (26-75 percent from same hospital), or high continuity (>75 percent from same hospital). The multivariable models included an interaction term to examine the potential moderating effects of facility type (freestanding facility vs. hospital-based rehabilitation unit) on the relationships between facility-level continuity and our two outcomes: community discharge and 30-day rehospitalization.<bold>Principal Findings: </bold>Medicare beneficiaries in hospital-based rehabilitation units were more likely to be referred from a high-contributing hospital compared to those in freestanding facilities. However, the association between higher acute-postacute continuity and desirable outcomes is significantly better in freestanding rehabilitation facilities than in hospital-based units.<bold>Conclusions: </bold>Improving continuity is a key premise of health care reform. We found that both observed referral patterns and continuity-related benefits differed markedly by facility type. These findings provide a starting point for health systems establishing or strengthening acute-postacute relationships to improve patient outcomes in this new era of shared accountability and public quality reporting programs.
- Subjects
UNITED States; ACUTE medical care; PATIENT aftercare; MEDICAL rehabilitation; HOSPITAL admission &; discharge; PATIENT readmissions; AGE distribution; CONTINUUM of care; FUNCTIONAL assessment; LENGTH of stay in hospitals; MEDICAL referrals; MEDICARE; POPULATION; REHABILITATION centers; RESEARCH funding; SEX distribution; SOCIAL support; DISCHARGE planning; RETROSPECTIVE studies
- Publication
Health Services Research, 2017, Vol 52, Issue 5, p1631
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12678