Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture.

OBJECTIVE: To examine the influence of diabetes on length of stay (LOS), functional status, and discharge setting in individuals with hip fracture. RESEARCH DESIGN AND METHODS: This work included secondary analyses of 79,526 individuals from 915 rehabilitation facilities in the U.S. Patients were classified into three groups using the Centers for Medicare and Medicaid Services comorbidity structure: individuals without diabetes (77.0%), individuals with non-tier diabetes (18.3%), and individuals with tier diabetes (4.7%). RESULTS: Mean age was 79.4 years (SD 9.6), and mean LOS was 13.3 days (SD 5.3). Tier diabetes was associated with longer LOS, lower functional status ratings, and reduced odds of discharge home when compared with individuals with no diabetes and non-tier diabetes. Statistically significant interactions (P < 0.05) were found between age and diabetes classification for LOS, functional status, and discharge setting. CONCLUSIONS: The impact of diabetes on recovery after hip fracture is moderated by age.

The Uniform Data System for Medical Rehabilitation: report of patients with hip fracture discharged from comprehensive medical programs in 2000-2007.

OBJECTIVE: The aim of this study was to provide benchmarking information for a large national sample of patients receiving inpatient rehabilitation because of a hip fracture. DESIGN: A secondary data analysis of records from 893 medical rehabilitation facilities located in the United States that contributed information to the Uniform Data System for Medical Rehabilitation from January 2000 through December 2007 was performed. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, and discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, International Classification of Diseases, Ninth Revision, codes for admitting diagnosis, comorbidities), and Functional Status Information (FIM instrument ratings at admission and discharge, FIM efficiency, and FIM gain). RESULTS: Descriptive statistics from 303,594 patients showed length of stay decreasing from a mean (SD) of 14.5 (7.9) days to 13.3 (5.5) days over the 8-yr study period. FIM total admission and discharge ratings also decreased. Mean admission ratings decreased from 72.5 (14.5) to 59.9 (15.7). Mean discharge ratings decreased from 95.8 (18.1) to 86.0 (19.8). FIM change per day remained relatively stable; mean for the entire sample was 2.1 (1.6). The percentage of persons discharged to the community also decreased across the study period, ranging from 77.8% in 2000 to 70.0% in 2007. All results are likely influenced by various policy changes affecting classification and/or documentation processes. CONCLUSIONS: National rehabilitation data from persons with hip fracture in 2000-2007 indicate that patients are spending less time in inpatient rehabilitation care than in previous years and are experiencing improvements in functional independence during their stay. In addition, most patients are discharged to the community after inpatient rehabilitation.

The uniform data system for medical rehabilitation: report of patients with lower limb joint replacement discharged from rehabilitation programs in 2000-2007.

OBJECTIVE: To provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation after lower limb joint replacement. DESIGN: Secondary data analysis from 893 medical rehabilitation facilities located in the United States that contributed information to the Uniform Data System for Medical Rehabilitation from January 2000 through December 2007. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, International Classification of Diseases, 9th revision codes for admitting diagnosis, comorbidities), and functional status information (FIM instrument ["FIM"] ratings at admission and discharge, FIM efficiency, FIM gain). RESULTS: Descriptive statistics from 705,345 patients showed an overall mean length of stay of 8.9 (±4.7) days. FIM total admission and discharge ratings declined during the 8-yr study period. Mean admission ratings decreased from 83.5 (±11.3) to 73.2 (±12.9). Mean discharge ratings decreased from 108.4 (±11.0) to 101.7 (±12.9). Conversely, mean FIM change increased from 24.9 (±9.2) to 28.6 (±12.2). The percent of persons discharged to the community decreased from 94.5% to 91.9%. All results are likely to be influenced by various policy changes affecting classification or documentation processes or both. CONCLUSIONS: National rehabilitation data from persons with lower limb joint replacement in 2000-2007 indicate that inpatient rehabilitation lengths of stay have remained relatively stable and that patients are experiencing improvements in functional independence during their stay. In addition, more than 9 of 10 patients are discharged to community settings after inpatient rehabilitation.

The uniform data system for medical rehabilitation: report of patients with traumatic brain injury discharged from rehabilitation programs in 2000-2007.

OBJECTIVE: To provide benchmarking information for a large national sample of patients receiving inpatient rehabilitation after traumatic brain injury. DESIGN: Secondary data analysis from 893 medical rehabilitation facilities located in the United States that contributed information to the Uniform Data System for Medical Rehabilitation from January 2000 through December 2007. Variables analyzed included demographic information (age, sex, marital status, race or ethnicity, prehospital living setting, and discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, Internation Classification of Diseases-9th revision codes for admitting diagnosis, and co-morbidities), and functional status information (FIM instrument [FIM] ratings at admission and discharge, FIM efficiency, FIM gain). RESULTS: Descriptive statistics from 101,188 patients showed length of stay decreasing from a mean of 22.7 (+/-20.5) days to 16.6 (+/-14.8) days during the 8-yr study period. FIM total admission and discharge ratings also decreased. Mean admission ratings decreased from 58.6 (+/-24.7) to 54.8 (+/-21.2). Mean discharge ratings decreased from 92.4 (+/-24.2) to 85.0 (+/-24.0). Accordingly, mean functional independence measure change decreased from 33.8 (+/-20.5) to 30.2 (+/-18.4). The percentage of patients discharged to the community settings ranged from 81.3% in 2000 to 74.1% in 2007. All results are likely influenced by various policy changes affecting classification or documentation processes or both. CONCLUSIONS: National rehabilitation data from persons with traumatic brain injury in 2000-2007 indicate that patients are spending less time in an inpatient care setting than in the previous years and are experiencing improvements in functional independence during their stay. In addition, a majority of patients are discharged to community settings after inpatient rehabilitation.

The uniform data system for medical rehabilitation: report of patients with stroke discharged from comprehensive medical programs in 2000-2007.

OBJECTIVE: To provide benchmarking information for a large national sample of patients receiving inpatient rehabilitation after a stroke. DESIGN: Analysis of secondary data from 893 medical rehabilitation facilities located in the United States and contributing information to the Uniform Data System for Medical Rehabilitation from 2000 to 2007. RESULTS: Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, and discharge setting), hospitalization information (length of stay, program interruptions, payer, event onset date, rehabilitation impairment group, International Classification of Diseases-9 codes for the admitting diagnosis, and comorbidities), and functional status information (FIM(R) instrument ["FIM"] ratings at admission and discharge, FIM efficiency, and FIM gain). Descriptive statistics revealed that the length of stay decreased from a mean of 19.6 (+/-12.8) days to 16.5 (+/-9.8) days during the 8-yr study period. FIM instrument admission and discharge ratings also decreased. Mean admission ratings decreased from 62.5 (+/-20.1) to 55.1 (+/-19.3), and mean discharge ratings decreased from 86.4 (+/-23.6) to 79.8 (+/-24.0). FIM change remained relatively stable; the mean for the entire sample was 23.9 (+/-14.8). The percent of persons discharged to the community ranged from 75.8% in 2000 to 69.3% in 2007. All results are likely affected by changes in the definition for program interruption and procedures for FIM data collection. CONCLUSION: Uniform Data System for Medical Rehabilitation data from persons with stroke receiving rehabilitation from 2000 to 2007 indicate patients are showing improvement in functional independence during their rehabilitation stay, and a large percentage are discharged to community settings.

Mammography facility characteristics and repeat mammography use among Medicare beneficiaries.

BACKGROUND: The goal of this study was to examine mammography facility characteristics and explore how such characteristics may impact repeat mammography use. METHODS: Mammography facility characteristics were obtained through a mailed a 21-item survey to Kansas mammography facilities. Medicare mammography claims were used to calculate facility-specific repeat mammography rates. Administrative data included female Kansas beneficiaries aged 65 years and older (N = 39,035) with a baseline mammogram during 1999. Beneficiaries with a mammography claim 12-18 months after their baseline mammogram were deemed to have had a repeat mammogram. RESULTS: Completed surveys were received from 90% (N = 79) of the 97 facilities serving >10 beneficiaries. Most facilities were in rural communities (58%), had an on-site radiologist (58%), and mailed mammography reminders to patients (63%). Extended hours of operation and the acceptance of self-referrals were uncommon (33% and 37%, respectively). Few facilities employed a quality improvement team (33%) or measured annual patient return rates (18%), but many measured patient satisfaction (57%). Of the beneficiaries, 61% had a repeat mammogram during the subsequent 12-18 months (range, 0% to 84%). Facilities notifying primary care providers of patients due for mammograms had higher repeat mammography rates. Multiple regression analyses found that higher repeat mammography rates were associated with facilities that accepted self-referrals, measured patient satisfaction, were in urban areas, and served a larger proportion of white beneficiaries. CONCLUSION: Mammography facility characteristics and repeat mammography rates vary widely. Although modifiable facility characteristics that may influence repeat mammography need additional study, results from this study indicate that mammography facilities are an opportunistic arena for quality improvement endeavors.

Variations in diabetes care and the influence of office systems.

Although a variety of office tools have been shown to improve diabetes care, the use and effectiveness of these tools outside the context of clinical trials is largely unknown. We surveyed primary care practices in Kansas. Using Medicare claims, we identified patients with diabetes, linked them to practices, and assessed the use of glycohemoglobin (GHb) tests, eye examinations, and lipid profiles. Performance rates among practices ranged from 15% to 100% (mean = 84%) for GHb tests, 20% to 100% (mean = 70%) for lipid profiles, and 50% to 100% (mean = 78%) for eye examinations. None of the practices used computerized tracking systems, 29% used diabetes flowsheets, and 33% allocated specific diabetes care responsibilities to nonphysician personnel. Neither use of flowsheets nor use of nonphysician personnel was associated with improvements in diabetes care. Although practices varied widely in their care of patients with diabetes, as currently implemented, office system tools have not led to consistently better performance.