Measure Title: Inpatient Rehabilitation Facility (IRF) Functional Outcome Measure: Change in Self-Care Score for Medical Rehabilitation Patients
NQF Measure Number: 2633
NQF Form Version:
Measure Steward: Centers for Medicare & Medicaid Services
Measure Description: This measure estimates the risk-adjusted mean change in self-care score between admission and discharge for Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients.
Numerator Statement: The measure does not have a simple form for the numerator and denominator. This measure estimates the risk-adjusted change in self-care score between admission and discharge among Inpatient Rehabilitation Facility (IRF) Medicare Part A and Medicare Advantage patients age 21 or older. The change in self-care score is calculated as the difference between the discharge self-care score and the admission self-care score.
Numerator Details: ${NumeratorDetails}
Denominator Statement: The denominator is the number of Inpatient Rehabilitation Facility Medicare patient stays, except those that meet the exclusion criteria.
Denominator Details: ${DenominatorDetails}
Exclusions: This quality measure has six patient-level exclusion criteria:
1) Patients with incomplete stays.
Rationale: When a patient has an incomplete stay, for example, the patients leave urgently due to a medical emergency, it can be challenging to gather accurate discharge functional status data. Patients with incomplete stays include patients who are unexpectedly discharged to an acute care setting (Short-stay Acute Hospital, Critical Access Hospital, Inpatient Psychiatric Facility, or Long-term Care Hospital); patients who die or leave an Inpatient Rehabilitation Facility (IRF) against medical advice; and patients with a length of stay less than 3 days.
2) Patients who are independent with all self-care activities at the time of admission.
Rationale: Patients who are independent with all the self-care items at the time of admission are assigned the highest score on all the self-care items, and thus, would not be able to show functional improvement on this same set of items at discharge.
3) Patients with the following medical conditions on admission: coma; persistent vegetative state; complete quadriplegia; locked-in syndrome; or severe anoxic brain damage, cerebral edema or compression of the brain.
Rationale: These patients are excluded because they may have limited or less predictable self-care improvement with the selected self-care items.
4) Patients younger than age 21.
Rationale: There is only limited evidence published about functional outcomes for individuals with Medicare who are younger than 21.
5) Patients discharged to Hospice.
Rationale: Patient goals may change during the IRF stay, and functional improvement may no longer be a goal for a patient discharged to hospice.
6) Patients who are not Medicare Part A and Medicare Advantage beneficiaries.
Rationale: IRF-PAI data for patients not covered by the Medicare program are not submitted to the Centers for Medicare and Medicaid Services.
Facility-level quality measure exclusion: For IRFs with fewer than 20 patient stays, data for this quality measure are not publicly reported.
Exclusion Details: ${DenominatorExclusionDetails}
Risk Adjustment: Statistical risk model
Corresponding Measures: Not Available
Endorsement Type: Endorsed
Initial Endorsement: Nov 04, 2015
Endorsement Date: Oct 25, 2019
Next Planned Maintenance Review:
Patient Experience and Function Spring 2024
Measure Type: Outcome
Measure Format: measure
Condition: Brain Injury, Falls and Traumatic Injury, Musculoskeletal, Stroke/Transient Ischemic Attack (TIA)
Non-Condition Specific: Health and Functional Status: Change
Care Setting: Post-Acute Care
National Quality Strategy Priorities: Person- and Family-Centered Care, Patient-Reported Outcomes
Current Use: Public Reporting, Quality Improvement (Internal to the specific organization), Quality Improvement with Benchmarking (external benchmarking to multiple organizations)
Planned Use: Public reporting
Data Source: Instrument-Based Data
Level of Analysis: Facility
Target Population: Individuals with multiple chronic conditions
Measure Selection Attributes: Outcome-Focused, Patient-and Caregiver-Focused
Measure Steward Organization: Centers for Medicare & Medicaid Services
Primary Measure Steward Contact: Helen.Dollar-Maples@cms.hhs.gov