| Sumario: | BACKGROUND: The Centers for Medicare & Medicaid Services implemented an inpatient rehabilitation facility (IRF) Quality Reporting Program as part of the Patient Protection and Affordable Care Act. To date, there are few quality measures used in IRFs based on patient-reported information. OBJECTIVES: The goals of this project were to (1) identify concerns important to the quality of care for a broad range of rehabilitation patients with neurological conditions that are amenable to the collection of data from rehabilitation patients, (2) evaluate the feasibility of collecting patient-reported information, and (3) specify items required for quality measure development that can be used in quality improvement efforts and to demonstrate accountability of health care delivery. METHODS: 1. Study Design: This mixed methods, prospective, multisite study obtained qualitative data (from focus groups) and quantitative data (patient-level data from 2 IRFs). Two reviewers coded focus group transcripts independently and the team reconciled discrepancies. A multistakeholder advisory committee evaluated the codes and helped to select key themes. We identified self-report instruments that reflected the quality themes.2. Data Sources/Study Setting: Five clinician, 5 former patient, and 2 caregiver focus groups helped identify quality concepts. Patients completed patient-reported outcome measures (PROMs) addressing some of these quality concepts shortly before discharge and 1 month later on a tablet computer or on paper. Quality measurement items came from the Hospital Consumer Assessment of Healthcare Providers and Systems, Care Transition Measure, Minimum Data Set and Patient-reported Outcomes Measurement Information System Pain Interference items.3. Data Collection: We administered 55 PROM items to inpatients with neurological disorders within a few days of discharge on a tablet or on paper. One month later, participants completed the same PROMs through an online link or mailing; we made up to 5 follow-up telephone calls to maximize the response rate. We used a top-box scoring method, calculated by dividing the number of patients fulfilling a criterion by the number of patients for whom the quality measure is appropriate, to calculate the percentage of positive responses. RESULTS: Focus groups identified 20 quality concepts; 5 concepts are particularly relevant to IRF care: rehabilitation goals, patient and family engagement, patient and family education, peer support, and discharge planning. Of 1055 patients with neurological conditions who were admitted to the IRFs, 74% were eligible, of whom 51% completed the inpatient PROM (N = 402). Of those who completed it, 73% did not require assistance using the tablet (85%) or paper (15%); 285 consented patients (69%) completed the postdischarge PROM, with 51% requiring multiple reminders. Five of the 20 quality concepts improved significantly between discharge and follow-up. Responses varied by patient characteristics; education was the most influential characteristic. CONCLUSIONS: Collection of PROMs from persons with neurological disorders is feasible. Most were able to use a tablet and willing to complete PROMs. Patient responses at follow-up typically were more favorable than discharge responses, revealing the importance of assessment timing. Risk adjustment of patient characteristics is critical given the variation in response rate across impairment groups. Results inform policy makers regarding feasibility of using PROM data in evaluating IRF quality. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: Data from only 2 IRFs limit generalizability of findings to other IRFs. Future studies should evaluate strategies to integrate patient-reported data into IRF routine care as well as evaluate patient-reported data with patients who have disabilities from nonneurological conditions and with a larger sample of IRFs.
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