Functional status is a frequently overlooked risk factor for readmissions and is a more valuable predictor of readmission risk than medical comorbidities in the medically complex inpatient rehabilitation population. These results add to the growing body of evidence that functional status is an important predictor of readmissions.

The challenge: Healthcare reform has put a strong focus on avoidable hospital readmissions, penalizing institutions that have higher-than-expected readmissions rates. A move from volume-based to value-based care rewards providers for a successful episode of care, breaking down the old, siloed, fee-for-service system. More than 2,200 hospitals were fined for avoidable readmissions in 2013, for a total of $280 million in reduced Medicare payments.

Title of Study: Functional Status Outperforms Comorbidities in Predicting Acute Care Readmissions in Medically Complex Patients

Shirley L. Shih, MD, Paul Gerrard, MD, Richard Goldstein PhD, Jacqueline Mix,
MPH, Colleen M. Ryan, MD, Paulette Niewczyk, PhD, Lewis Kazis, ScD, Jaye
Hefner, MD, D. Clay Ackerly, MD, MSc, Ross Zafonte, DO, and Jeffrey C.
Schneider, MD

This study of over 12,000 medically complex patients in the Uniform Data System for Medical Rehabilitation admitted to inpatient rehabilitation facilities compared functional status to medical comorbidities as predictors of acute care readmissions.

Summary of Findings: The study found that functional status – as measured by FIM, or functional independence measure – was a better predictor of acute care readmissions than medical comorbidities were, and lower functional status was correlated with a higher risk of readmission.

• The study examined 3, 7 and 30-day readmissions under the hypothesis that early readmissions tend to represent more preventable readmissions
• The lowest functioning patients had the highest rates of readmission
• The C statistic of a logistic model designed to predict hospital readmissions was .69 using just functional status as compared to .57 using just comorbidities. It only jumps .01 by adding comorbidites to functional status, meaning that functional status alone is an effective predictor of readmissions

readmissions study chart