期刊
HEALTH SERVICES RESEARCH
卷 52, 期 5, 页码 1631-1646出版社
WILEY
DOI: 10.1111/1475-6773.12678
关键词
Referrals and referral networks; rehabilitation services; Medicare; hospitals; quality of care; patient safety (measurement)
资金
- National Institutes of Health (NIH) [P2C HD065702, R01 HD069443]
- National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) [90IF0071]
ObjectiveTo examine the effects of facility-level acute-postacute continuity on probability of community discharge and 30-day rehospitalization following inpatient rehabilitation. Data SourcesWe 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 DesignWe 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 FindingsMedicare 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. ConclusionsImproving 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.
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