Hospital Readmission and Inpatient Medical Rehabilitation

描述（由申请人提供）：《患者保护和负担得起的医疗法案》创建了“减少医院再入院计划”，以帮助急症护理医院减少可避免的再住院。研究表明，大约20%的医疗保险患者在急症护理出院后30天内再次住院，而这些再次住院中的大多数是可以预防的。检查再住院的研究主要集中在从急症医院出院的患者身上。我们将调查接受住院医疗康复的高容量和高费用患者的再入院率和原因，例如中风或髋部骨折患者。这是一个未被充分研究的人群，随着美国人口持续老龄化，这对医疗资源和成本具有重要意义。我们的目标是确定六个最大的康复障碍群体中接受住院康复服务的人的再入院率和相关因素

DESCRIPTION (provided by applicant): The Patient Protection and Affordable Care Act creates a "hospital readmission reduction program" to help acute care hospitals decrease avoidable rehospitalizations. Research suggests approximately twenty percent of all Medicare patients are rehospitalized within 30 days of discharge from acute care and that the majority of these rehospitalizations are preventable. Research examining rehospitalization has focused primarily on patients discharged from acute care hospitals. We will examine rates and reasons for hospital readmission in high volume and high cost patients, such as those with stroke or hip fracture, who receive inpatient medical rehabilitation. This is an understudied population with important implications for health care resources and costs as the U.S. population continues to age. Our goal is to determine rates and factors associated with hospital readmissions in persons receiving inpatient rehabilitation services for the six largest rehabilitation impairment groups as defined by the Centers for Medicare and Medicaid Services (CMS). We propose the following Specific Aims: Aim 1. Examine national data from the Centers for Medicare and Medicaid Services and the Uniform Data System for Medical Rehabilitation (UDSMR) to determine rates of hospital readmission for the six largest impairment groups receiving inpatient medical rehabilitation in the U.S. (stroke, fracture of the lower extremity, joint replacement of the lowe extremity, debility, neurological disorders and traumatic brain injury) (MedPAC, 2011). Aim 2. Determine patient characteristics (sociodemographic and clinical/functional) associated with hospital readmission across the six impairment groups (see Aim 1). We will examine data from the Centers for Medicare and Medicaid Services files and the Uniform Data System for Medical Rehabilitation dataset for the years 2006 - 2010 (~ 1.3 million patient records). We will use exploratory data analysis and descriptive statistics to determine the rate of hospital readmission for the six rehabilitation impairment categories. Time-to-event survival analyses will be used to examine personal and clinical factors associated with hospital readmission during the first 90 days after discharge. Our interdisciplinary research team has twenty years of experience using large national datasets to study rehabilitation outcomes. The findings will address priorities of the Affordable Care Act, provide information useful in developing future predictive models, and assist in documenting hospital accountability and establishing quality indicators.