Eli's Rehab Report

Published on Tue Dec 06, 2016 PDF

While as many as one in three patients with neurological conditions in an inpatient rehabilitation facility experience interruptions in care, a study published in the American Journal of Physical Medicine and Rehabilitation found that 10 percent of those interruptions are caused by “potentially preventable” conditions.

Taking a closer look at these occurrences, according to the authors of the article, could provide opportunities to improve patient outcomes while lowering the costs of care.

The study, which looked at data from nearly 80,000 Medicare beneficiaries admitted to an IRF for services related to stroke, traumatic brain injury (TBI), and spinal cord injury (SCI) between 2012 and 2013, focused on the prevalence and causes of two types of interruptions in care: “program interruptions” and “short-stay transfers.”

Researchers found that program interruptions — when patients are transferred to another facility and returned to the IRF within 3 days — occurred in about one percent of patients. In nearly all cases reviewed, the patient was transferred to an acute care hospital.

Meanwhile, short-stay transfers — when patients are transferred to a hospital, skilled nursing facility, or other facility before their expected IRF length-of-stay ends — occurred in about 22 percent of patients with stroke or TBI, and nearly 32 percent of those with SCI. About one-third of short-stay transfer patients were also transferred back to acute-care hospitals, while others were transferred to skilled nursing facilities.

Potentially Preventable

Across groups, researchers found that about 11-12 percent of program interruptions might have been preventable. Of these conditions, dehydration and heart failure (30.6 percent and 26.8 percent, respectively) were most common among individuals with stroke. Dehydration and bacterial pneumonia were just as prevalent among the TBI group (26.4 percent for both). The most prevalent preventable conditions for SCI patients were bacterial pneumonia and urinary tract infections (66.7 percent and 33.3 percent, respectively).

Of the short-term transfers, about 15 percent were potentially preventable in the patients with stroke, 10 percent with brain injury, and 4 percent with SCI. These preventable causes included problems like dehydration, heart failure, pneumonia, and urinary tract infections.

Potential Cost Savings

Reducing rates of program interruptions and short-stay transfers will not just improve patient experiences of care, say study authors, they will likely also translate to lower Medicare spending per beneficiary as bundled payments become increasingly prevalent.

Note: Read the entire American Journal of Physical Medicine and Rehabilitation study here: http://journals.lww.com/ajpmr/Citation/2016/11000/Program_Interruptions_and_Short_Stay_Transfers.9.aspx.