Steward no longer seeking to maintain endorsement
This measure estimates the risk-adjusted mean change in self-care score between admission and discharge for Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients.
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1.14 Numerator
The measure does not have a simple form for the numerator and denominator. This measure estimates the risk-adjusted change in self-care score between admission and discharge among Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients age 21 or older. The change in self-care score is calculated as the difference between the discharge self-care score and the admission self-care score.
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1.15 Denominator
The denominator is the number of Inpatient Rehabilitation Facility Medicare patient stays, except those that meet the exclusion criteria.
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Exclusions
This quality measure has six patient-level exclusion criteria:
1) Patients with incomplete stays.
Rationale: When a patient has an incomplete stay, for example, the patients leave urgently due to a medical emergency, it can be challenging to gather accurate discharge functional status data. Patients with incomplete stays include patients who are unexpectedly discharged to an acute care setting (Short-stay Acute Hospital, Critical Access Hospital, Inpatient Psychiatric Facility, or Long-term Care Hospital); patients who die or leave an Inpatient Rehabilitation Facility (IRF) against medical advice; and patients with a length of stay less than 3 days.
2) Patients who are independent with all self-care activities at the time of admission.
Rationale: Patients who are independent with all the self-care items at the time of admission are assigned the highest score on all the self-care items, and thus, would not be able to show functional improvement on this same set of items at discharge.
3) Patients with the following medical conditions on admission: coma; persistent vegetative state; complete quadriplegia; locked-in syndrome; or severe anoxic brain damage, cerebral edema or compression of the brain.
Rationale: These patients are excluded because they may have limited or less predictable self-care improvement with the selected self-care items.
4) Patients younger than age 21.
Rationale: There is only limited evidence published about functional outcomes for individuals with Medicare who are younger than 21.
5) Patients discharged to Hospice.
Rationale: Patient goals may change during the IRF stay, and functional improvement may no longer be a goal for a patient discharged to hospice.
6) Patients who are not Medicare Part A and Medicare Advantage beneficiaries.
Rationale: IRF-PAI data for patients not covered by the Medicare program are not submitted to the Centers for Medicare and Medicaid Services.
Facility-level quality measure exclusion: For IRFs with fewer than 20 patient stays, data for this quality measure are not publicly reported.
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1.13a Data dictionary not attachedNo
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Most Recent Endorsement ActivityEndorsed Patient Experience and Function Spring Cycle 2019Initial EndorsementLast UpdatedRemoval Date
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StewardCenters for Medicare & Medicaid ServicesSteward Organization POC EmailSteward Organization Copyright
Not applicable
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Risk AdjustmentRisk adjustment approachOffRisk adjustment approachOffConceptual model for risk adjustmentOffConceptual model for risk adjustmentOff
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6.1.2 Current or Planned Use(s)
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Planned UseUse In Federal Program
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