PMID- 28580725
OWN - NLM
STAT- MEDLINE
DCOM- 20170912
LR  - 20240326
IS  - 1475-6773 (Electronic)
IS  - 0017-9124 (Print)
IS  - 0017-9124 (Linking)
VI  - 52
IP  - 5
DP  - 2017 Oct
TI  - Effects of Acute-Postacute Continuity on Community Discharge and 30-Day 
      Rehospitalization Following Inpatient Rehabilitation.
PG  - 1631-1646
LID - 10.1111/1475-6773.12678 [doi]
AB  - OBJECTIVE: To examine the effects of facility-level acute-postacute continuity on 
      probability of community discharge and 30-day rehospitalization following 
      inpatient rehabilitation. DATA SOURCES: We used national Medicare enrollment, 
      claims, and assessment data to study 541,097 patients discharged from 1,156 
      inpatient rehabilitation facilities (IRFs) in 2010-2011. STUDY DESIGN: We 
      calculated facility-level continuity as the percentages of an IRF's patients 
      admitted from each contributing acute care hospital. Patients were categorized 
      into three groups: low continuity (<26 percent from same hospital that discharged 
      the patient), medium continuity (26-75 percent from same hospital), or high 
      continuity (>75 percent from same hospital). The multivariable models included an 
      interaction term to examine the potential moderating effects of facility type 
      (freestanding facility vs. hospital-based rehabilitation unit) on the 
      relationships between facility-level continuity and our two outcomes: community 
      discharge and 30-day rehospitalization. PRINCIPAL FINDINGS: Medicare 
      beneficiaries in hospital-based rehabilitation units were more likely to be 
      referred from a high-contributing hospital compared to those in freestanding 
      facilities. However, the association between higher acute-postacute continuity 
      and desirable outcomes is significantly better in freestanding rehabilitation 
      facilities than in hospital-based units. CONCLUSIONS: Improving continuity is a 
      key premise of health care reform. We found that both observed referral patterns 
      and continuity-related benefits differed markedly by facility type. These 
      findings provide a starting point for health systems establishing or 
      strengthening acute-postacute relationships to improve patient outcomes in this 
      new era of shared accountability and public quality reporting programs.
CI  - (c) Health Research and Educational Trust.
FAU - Graham, James E
AU  - Graham JE
AD  - Division of Rehabilitation Sciences, University of Texas Medical Branch, 
      Galveston, TX.
FAU - Prvu Bettger, Janet
AU  - Prvu Bettger J
AD  - Department of Orthopaedic Surgery, Duke Medicine, Durham, NC.
FAU - Middleton, Addie
AU  - Middleton A
AD  - Division of Rehabilitation Sciences, University of Texas Medical Branch, 
      Galveston, TX.
FAU - Spratt, Heidi
AU  - Spratt H
AD  - Office of Biostatistics, Department of Preventive Medicine & Community Health, 
      University of Texas Medical Branch, Galveston, TX.
FAU - Sharma, Gulshan
AU  - Sharma G
AD  - Division of Pulmonary Critical Care and Sleep Medicine, University of Texas 
      Medical Branch, Galveston, TX.
FAU - Ottenbacher, Kenneth J
AU  - Ottenbacher KJ
AD  - Division of Rehabilitation Sciences, University of Texas Medical Branch, 
      Galveston, TX.
LA  - eng
GR  - P2C HD065702/HD/NICHD NIH HHS/United States
GR  - R01 HD069443/HD/NICHD NIH HHS/United States
GR  - R24 HD065702/HD/NICHD NIH HHS/United States
PT  - Journal Article
DEP - 20170605
PL  - United States
TA  - Health Serv Res
JT  - Health services research
JID - 0053006
SB  - IM
CIN - Health Serv Res. 2017 Oct;52(5):1629-1630. PMID: 28580588
CIN - Health Serv Res. 2017 Oct;52(5):1621-1628. PMID: 28580644
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Continuity of Patient Care/*statistics & numerical data
MH  - Disability Evaluation
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Medicare/statistics & numerical data
MH  - Patient Discharge/*statistics & numerical data
MH  - Patient Readmission/*statistics & numerical data
MH  - Racial Groups
MH  - Referral and Consultation/*statistics & numerical data
MH  - Rehabilitation Centers/*statistics & numerical data
MH  - Retrospective Studies
MH  - Sex Factors
MH  - Social Support
MH  - United States
PMC - PMC5583304
OTO - NOTNLM
OT  - Medicare
OT  - Referrals and referral networks
OT  - hospitals
OT  - quality of care/patient safety (measurement)
OT  - rehabilitation services
EDAT- 2017/06/06 06:00
MHDA- 2017/09/13 06:00
PMCR- 2018/10/01
CRDT- 2017/06/06 06:00
PHST- 2017/06/06 06:00 [pubmed]
PHST- 2017/09/13 06:00 [medline]
PHST- 2017/06/06 06:00 [entrez]
PHST- 2018/10/01 00:00 [pmc-release]
AID - HESR12678 [pii]
AID - 10.1111/1475-6773.12678 [doi]
PST - ppublish
SO  - Health Serv Res. 2017 Oct;52(5):1631-1646. doi: 10.1111/1475-6773.12678. Epub 
      2017 Jun 5.