Article

OBJECTIVE: To evaluate the impact of Medicare's inpatient rehabilitation facility
(IRF) prospective payment system (PPS) on use of inpatient rehabilitation for
individuals with traumatic brain injury (TBI). DESIGN: Retrospective cohort study
of patients with TBI. SETTING: One hundred twenty-three level I and II trauma
centers across the U.S. who contributed data to the National Trauma Data Bank.
PARTICIPANTS: Patients (N=135,842) with TBI and an Abbreviated Injury Score of
the head of 2 or greater admitted to trauma centers between 1995 and 2004.
INTERVENTIONS: None. MAIN OUTCOME MEASURE: Discharge location: IRF, skilled
nursing facility, home, and other hospitals. RESULTS:
Compared with inpatient
rehabilitation admissions before IRF PPS came into effect, demographic
characteristics of admitted patients changed. Those admitted to acute care trauma
centers after PPS was enacted (January 2002) were older and nonwhite. No
differences were found in rates of injury between men and women. Over time, there
was a significant drop in the percent of patients being discharged to inpatient
rehabilitation, which varied by region, but was found across all insurance types.
In a logistic regression, after controlling for patient characteristics (age,
sex, race), injury characteristics (cause, severity), insurance type, and
facility, the odds of being discharged to an IRF after a TBI decreased 16% after
Medicare's IRF PPS system was enacted. CONCLUSIONS: The enactment of the Medicare
PPS appears to be associated with a reduction in the chance that patients receive
inpatient rehabilitation treatment after a TBI. The impact of these changes on
the cost, quality of care, and patient outcome is unknown and should be addressed
in future studies.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS