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The Unmet Need for Postacute Rehabilitation Among Medicare Observation Patients: A Single‐Center Study
Author(s) -
Goldstein Jennifer N.,
Schwartz J. Sanford,
McGraw Patricia,
Banks Tobias L.,
Hicks LeRoi S.
Publication year - 2017
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2700
Subject(s) - medicine , center (category theory) , rehabilitation , medline , physical therapy , family medicine , physical medicine and rehabilitation , law , chemistry , crystallography , political science
BACKGROUND Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs. OBJECTIVE To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization. DESIGN/SETTING Observational study using electronic medical record and administrative data from a regional health system. PATIENTS 1323 community‐dwelling Medicare patients admitted under observation status. MEASUREMENTS Summary statistics were calculated for demographic and administrative variables. Physical therapy (PT) and case management recommendations for a representative sample of 386 medical records were reviewed regarding need for PAIR services. Linear regression was used to measure the association between PT recommendation and hospital length of stay, adjusting for ICD‐9 ( International Classification of Diseases, Ninth Revision ) diagnosis, age, sex, and provider. Chi‐square test was used to determine the association between PT recommendation and 30‐day hospital revisit. RESULTS Of the 1323 study patients, 11 (0.83%) were discharged to PAIR facilities. However, 17 (4.4%) of the 386 patients whose charts were reviewed received a recommendation for this care. Adjusted mean hospital stay was longer ( P < 0.001) for patients recommended for rehabilitation (75.9 h) than for patients with no PT needs (46.8 h). In addition, the 30‐day hospital revisit rate was higher ( P = 0.037) for the patients who had been recommended for rehabilitation (52.9%, 9/17) than for those who had not (25.4%, 30/118). CONCLUSIONS Medicare observation patients' potential need for PAIR services is 5‐ to 6‐fold higher than their use of these services. Observation patients recommended for this care may have worse outcomes.