Geographic and Facility Variation in Inpatient XXXX Rehabilitation: Multilevel Analysis of Functional Status.

@entity1 @entity64 @entity25266
OBJECTIVE: To examine geographic and facility variation in cognitive and motor functional outcomes after postacute inpatient rehabilitation in @entity1 with @entity64 . DESIGN: Retrospective cohort design using Centers for Medicare and Medicaid Services ( @entity25266 ) claims files. Records from 1209 rehabilitation facilities in 298 hospital referral regions (HRRs) were examined. @entity1 records were analyzed using linear mixed models. Multilevel models were used to calculate the variation in outcomes attributable to facilities and geographic regions. SETTING: Inpatient rehabilitation units and facilities. @entity1 : @entity1 (N=145,460) with @entity64 discharged from inpatient rehabilitation from 2006 through 2009. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Cognitive and motor functional status at discharge measured by items in the @entity25266 Inpatient Rehabilitation Facility- @entity1 Assessment Instrument. RESULTS: Variation profiles indicated that 19.1% of rehabilitation facilities were significantly below the mean functional status rating (mean    SD, 81.58  22.30), with 221 facilities (18.3%) above the mean. Total discharge functional status ratings varied by 3.57 points across regions. Across facilities, functional status values varied by 29.2 points, with a 9.1-point difference between the top and bottom deciles. Variation in discharge motor function attributable to HRR was reduced by 82% after controlling for cluster effects at the facility level. CONCLUSIONS: Our findings suggest that variation in motor and cognitive function at discharge after postacute rehabilitation in @entity1 with @entity64 is accounted for more by facility than geographic location.
