Health Services Research
Quality Improvement and Implementation Science
This research examined whether inpatient rehabilitation facility (IRF) patients' change in function scores differed by their pre-hospitalization living situation (i.e., living alone) and socioeconomic status (SES). Using IRF-Patient Assessment Instrument (PAI) data for Medicare patients discharged during 2017, we calculated risk-adjusted functional outcome scores using the Section GG self-care and mobility admission and discharge items. The results indicate that IRF Medicare patients who lived alone or had lower SES had slightly more functional improvement during their IRF stay than patients living with others or with the highest SES, respectively.
To examine living situation (i.e., living alone), socioeconomic status (SES), and functional outcomes for patients discharged from inpatient rehabilitation facilities (IRFs).
Cohort study of IRF-Patient Assessment Instrument (PAI) data for Medicare patients discharged during 2017 (January–December). Functional outcome scores were determined using the Section GG self-care and mobility admission and discharge items. SES was calculated using the AHRQ SES Index method.
All IRFs (N=1,129) that submitted IRF-PAI records for discharges to the Centers for Medicare & Medicaid Services (CMS).
Participants (or Animals, Specimens, Cadavers):
All Medicare patients (N=493,209) discharged in 2017. Patients were 65 or older (86.5%), female (53.0%) and white (79.2%). About 29% lived alone and 25% had the lowest SES prior to hospitalization.
Main Outcome Measure(s):
(1) Change in self-care score (range: 7-42). (2) Change in mobility score (range: 15-90). We hypothesized that patients who lived alone or had lower SES would have higher change scores than patients living with others or with the highest SES, respectively. We performed GLM regression analyses to identify change in function scores, controlling for risk factors (e.g., age, primary diagnosis, prior functioning and device use, admission functioning, cognition, comorbidities).
Patients who lived alone had slightly higher change in self-care scores (0.4732, p < 0.001) and change in mobility scores (0.8362, p < 0.001) than those not living alone. Lower SES was associated with slightly higher change scores compared to the highest SES. Effects were largest for the lowest SES (Self-Care, 0.5516, p < 0.001; Mobility, 0.7917, p < 0.001).
IRF Medicare patients living alone and those with low SES had slightly more functional improvement during their IRF stay compared to patients living with others and those in the highest SES group, respectively.