Hospital readmissions in brain dysfunction or neurological conditions after inpatient medical rehabilitation

Identify 30-day hospital readmission rates in Medicare beneficiaries with brain dysfunction and neurological conditions who required intensive inpatient medical rehabilitation following hospital discharge. Secondary analysis of Medicare fee-for-service data using Inpatient Rehabilitation Facilities Patient Assessment Instrument (IRF-PAI) and Medicare Provider Analysis and Review (MEDPAR) data files. We selected patients with brain dysfunction (n=37,890; traumatic, non-traumatic brain injury) or neurological conditions (n=42,600; Parkinson's, neuromuscular disorders, etc.) who were admitted to inpatient rehabilitation facilities from acute hospitals in 2006-2009, were completing their initial rehabilitation stay, living in the community prior to acute hospitalization, age 66 or older, and who did not experience a program interruption during their rehabilitation stay. Hospital readmission (yes/no) was determined for those patients who were discharged to community settings after rehabilitation stay. The observation period extended to 30 days after discharge from the acute hospital stay. The 30-day readmission rates were approximately 11% (n=4,333) and 12% (n=5,223) for brain dysfunction and neurological conditions, respectively. For both impairment groups, the proportions of comorbidities were greater and more severe in the readmission group compared to those without readmission. Rehabilitation length of stay and functional status at the time of discharge were lower in the readmission group as compared to those without readmission. Rehospitalization rates are not only established quality indicators, but they can also directly affect Medicare reimbursements. Thus, it is increasingly important to identify high-risk patients, improve care transitions, and increase continuity across contiguous venues representing an entire episode of care.