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Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients

CBE ID
2633
1.4 Project
Patient Experience and Function
Endorsed
Endorsement Status
Endorsed
1.1 New or Maintenance
Maintenance
E&M Cycle
Spring 2019
Is Under Review
No
Next Planned Maintenance Review
Patient Experience and Function Spring 2024
1.3 Measure Description

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.

    • 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.

    • 1.15 Denominator

      The denominator is the number of Inpatient Rehabilitation Facility Medicare patient stays, except those that meet the exclusion criteria.

    • 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.

    • Most Recent Endorsement Activity
      Endorsed Patient Experience and Function Spring Cycle 2019
      Initial Endorsement
      Last Updated