Mandated quality of care metrics for Medicare patients: Examining new or worsened pressure ulcers and rehabilitation outcomes in United States inpatient rehabilitation facilities

Publication date: Available online 9 April 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Margaret A. DiVita, Carl V. Granger, Richard Goldstein, Paulette M. Niewczyk, Jo L. Freudenheim
ObjectiveTo examine the association between the Medicare pressure ulcer quality indicator (the development of new or worsened pressure ulcers), with rehabilitation outcomes among Medicare patients seen in an inpatient rehabilitation facility (IRF). Data collection on the pressure ulcer quality indicator began in October of 2012, however, the value of this indicator is not known.DesignRetrospective descriptive study.SettingIRFs subscribed to the Uniform Data System for Medical Rehabilitation. Participants: Nearly 500,000 IRF Medicare patients who were discharged between January 2013 and September 2014 were examined.InterventionNA.Main Outcome MeasuresFunctional independence, functional change (gain), and discharge destination.ResultsThe pressure ulcer quality indicator was associated with poorer rehabilitation outcomes; patients were less likely to achieve functional independence (OR 0.47, 95% CI 0.44 - 0.51), less likely to be discharged to a community setting (OR 0.88, 95% CI: 0.82 - 0.95) and made less functional gain during their IRF stay (a difference of 6 FIM points).ConclusionThese results support that the pressure ulcer quality indicator is associated with lower quality of rehabilitation outcomes; however given that those patients with a new or worsened pressure injury still made functional gains and most were discharged to the community, the risk of pressure injury development should not preclude the admission of these cases to an IRF.



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