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

CBE ID
2634
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 mean risk-adjusted mean change in mobility 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 mobility score between admission and discharge among Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients age 21 and older. The change in mobility score is calculated as the difference between the discharge mobility score and the admission mobility score.

    • 1.15 Denominator

      The denominator is the number of Inpatient Rehabilitation Facility Medicare Part A and Medicare Advantage 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 mobility activities at the time of admission.
      Rationale: Patients who are independent with all the mobility items (with the exception of the wheelchair items GG0170R and GG0170S) at the time of admission are assigned the highest score on all the mobility 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 brain.
      Rationale: These patients are excluded because they may have limited or less predictable mobility improvement with the selected mobility 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