RTI International, Chicago, IL.
RTI International, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Arch Phys Med Rehabil. 2018 Jun;99(6):1035-1041. doi: 10.1016/j.apmr.2017.02.023. Epub 2017 Mar 28.
To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016.
Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability.
IRFs.
Medicare FFS patients aged ≥21 years (N=4769).
Not applicable.
Facility-level discharge self-care quality measure performance score.
A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged <65 years. Stroke was the most common diagnosis (21.8%). The mean±SD performance score was 55.1%±16.6% (range, 25.8%-100%). About 54% of IRFs had scores significantly different from the percentage of stays that met or exceeded the expected discharge self-care score in the overall demonstration sample. The quality measure showed strong reliability, with intraclass correlation coefficients of .91.
The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs.
描述 2016 年 10 月 1 日在医疗保险和医疗补助服务中心（CMS）住院康复机构（IRF）质量报告计划中实施的出院自我护理功能状态质量测量的计算和心理测量特性。
参与 CMS 后期护理支付改革示范项目的 38 个 IRF 的 Medicare 按服务收费（FFS）患者被纳入本队列研究。数据来自连续性评估记录和评估项目集、IRF-患者评估工具和 Medicare 索赔。对于每个患者，我们根据人口统计学和基线临床特征对预期的出院自我护理评分进行风险调整。每个 IRF 的绩效评分等于观察到的出院自我护理评分符合或超过预期评分的患者入住率的百分比。我们评估了该测量在 IRF 之间的区分能力和可靠性。
IRF。
年龄≥21 岁的 Medicare FFS 患者（N=4769）。
不适用。
机构级出院自我护理质量测量绩效评分。
共纳入 4769 例患者住院；57%的住院患者为女性，12.1%的住院患者年龄<65 岁。最常见的诊断是中风（21.8%）。平均±SD 绩效评分 55.1%±16.6%（范围 25.8%-100%）。约 54%的 IRF 的评分与整个示范样本中符合或超过预期出院自我护理评分的住院患者比例显著不同。质量测量具有很强的可靠性，组内相关系数为.91。
出院自我护理质量测量具有很强的区分能力和可靠性，代表了对 IRF 自我护理结果评估的重要初步步骤。绩效评分的广泛差异表明 IRF 之间的护理质量存在差距。未来的工作应包括使用来自所有 IRF 的全国性数据对该测量进行测试。
