Original researchSocial Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities
Section snippets
Data source
Medicare data were obtained from the CMS. We selected patients discharged from IRFs in 2012 using the 100% Inpatient Rehabilitation Facility–Patient Assessment Instrument file. We then linked the assessment data from those cases to the claims data in the Medicare Provider Analysis and Review file and the enrollment and demographic data in the Beneficiary Summary File.10, 11 A data usage agreement was established with the CMS, and the study was approved by the university's institutional review
Results
Table 1 provides sample characteristics for the 3 impairment groups. Mean ages ± SD ranged from 73.2±9.2 years for joint replacement to 79.7±9.4 years for fracture. The percentages of patients reporting they have family or friends, or both, for social support for fracture, joint replacement, and stroke were 62%, 65%, and 69%, respectively. Admission FIM motor ratings ranged from 35.8±10.0 for fracture to 42.7±9.2 for joint replacement. The percentages of patients with no tier comorbidities were
Discussion
Many studies2, 3, 4, 5 have reported on the trend in decreasing lengths of stay since implementation of the IRF prospective payment system and have examined the potential impacts of these shorter stays on clinical outcomes. However, there is no published information on the degree to which the Medicare inpatient rehabilitation population deviates from its condition-specific expected lengths of stay, or on patient characteristics that may be associated with either shorter- or longer-than-expected
Conclusions
Almost half of Medicare beneficiaries receiving inpatient rehabilitation services for stroke, lower extremity fracture, and joint replacement are discharged more than 1 day earlier than expected. Our findings provide new information on variables influencing length of stay to the growing body of evidence that inpatient rehabilitation experiences and outcomes can be substantially affected by a patient's level of social support. More research is needed to better understand the effects of social
Supplier
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SAS for Windows, version 9.3; SAS Institute, Inc.
Acknowledgments
We thank Jessica M. Jarvis, BS, and Ioannis Malagaris, MS, for their contributions in formulating and designing the project and their critical feedback during the development of this manuscript.
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Supported in part by the National Institutes of Health (grant nos. P2CHD065702 and K01HD086290) and the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90IF0071).
Disclosures: none.