LAUSR

OBJECTIVE To describe the exclusion criteria and risk-adjustment model developed for the quality measure Change in Self-Care. The exclusion criteria and risk adjustment model are used to calculate Change in Self-Care scores allowing scores to be compared across IRFs. DESIGN This national cohort study examined admission demographic and clinical factors associated with IRF patients' self-care change scores using standardized self-care data for Medicare patients discharged in calendar year 2017. SETTING 1,129 IRFs in the United States Participants: A total of 493,209 Medicare Fee-for-Service and Medicare Advantage IRF patient stays Interventions: Not applicable. MAIN OUTCOME MEASURE(S) Self-care change scores using admission and discharge standardized assessment data elements from the IRF-patient assessment instrument (IRF-PAI). RESULTS Approximately 53% of patients were female, and 67% were between 65 and 84 years old. The final risk-adjustment model contained 93 clinically-relevant risk adjusters and explained 23.1% of variance in self-care change scores. Risk adjusters that had the greatest impact on change scores included IRF primary diagnosis group (i.e., binary risk adjusters representing 13 diagnoses), prior self-care functioning, and age greater than 90 years. When split by deciles of expected scores, the ratio of the average expected and observed change scores was within 2% of 1.0 across 8 groups and within 8% at the extremes, showing good predictive accuracy. CONCLUSION(S) The risk adjustment model quantifies the relationship between IRF patients' demographic and clinical characteristics and their self-care score changes. The exclusion criteria and model are used to risk-adjust the IRF Change in Self-Care quality measure.