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Addressing non-response data for standardized post-acute functional items.

Authors :
Li, Chih -Ying
Kim, Hyunkyoung
Downer, Brian
Lee, Mi Jung
Ottenbacher, Kenneth
Kuo, Yong-Fang
Source :
BMC Health Services Research. 9/6/2023, Vol. 23 Issue 1, p1-12. 12p. 4 Charts.
Publication Year :
2023

Abstract

Background: The post-acute patient standardized functional items (Section GG) include non-response options such as refuse, not attempt and not applicable. We examined non-response patterns and compared four methods to address non-response functional data in Section GG at nation-wide inpatient rehabilitation facilities (IRF). Methods: We characterized non-response patterns using 100% Medicare 2018 data. We applied four methods to generate imputed values for each non-response functional item of each patient: Monte Carlo Markov Chains multiple imputations (MCMC), Fully Conditional Specification multiple imputations (FCS), Pattern-mixture model (PMM) multiple imputations and the Centers for Medicare and Medicaid Services (CMS) approach. We compared changes of Spearman correlations and weighted kappa between Section GG and the site-specific functional items across impairments before and after applying four methods. Results: One hundred fifty-nine thousand six hundred ninety-one Medicare fee-for-services beneficiaries admitted to IRFs with stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility. At discharge, 3.9% (self-care) and 61.6% (mobility) of IRF patients had at least one non-response answer in Section GG. Patients tended to have non-response data due to refused at discharge than at admission. Patients with non-response data tended to have worse function, especially in mobility; also improved less functionally compared to patients without non-response data. Overall, patients coded as 'refused' were more functionally independent in self-care and patients coded as 'not applicable' were more functionally independent in transfer and mobility, compared to other non-response answers. Four methods showed similar changes in correlations and agreements between Section GG and the site-specific functional items, but variations exist across impairments between multiple imputations and the CMS approach. Conclusions: The different reasons for non-response answers are correlated with varied functional status. The high proportion of patients with non-response data for mobility items raised a concern of biased IRF quality reporting. Our findings have potential implications for improving patient care, outcomes, quality reporting, and payment across post-acute settings. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
14726963
Volume :
23
Issue :
1
Database :
Academic Search Index
Journal :
BMC Health Services Research
Publication Type :
Academic Journal
Accession number :
171581071
Full Text :
https://doi.org/10.1186/s12913-023-09982-8