Risk-adjusted mean change in mobility scores from admission to discharge.

The measure does not have a simple form for the numerator and denominator. This measure estimates the risk-adjusted change in mobility score between admission and discharge among Inpatient Rehabilitation Facility (IRF) Medicare patients age 18 or older. The change in mobility score is calculated as the difference between the discharge mobility score and the admission mobility score.**Admission and discharge functional assessment items included in this measure are GG0170A1/A3, GG0170B1/B3, GG0170C1/C3, GG0170D1/D3, GG0170E1/E3, GG0170F1/F3, GG0170G1/G3, GG0170I1/I3, GG0170J1/J3, GG0170K1/K3, GG0170L1/L3, GG0170M1/M3, GG0170N1/N3, GG0170O1/O3, GG0170P1/P3, GG0170R1/R3, and GG0170S1/S3.

The total number of IRF stays with a discharge date in the measure target period, which do not meet the exclusion criteria.

An IRF stay is excluded if: Patient had an incomplete stay: • Discharge destination (Item 44D = [02, 63, 65, 66]): Discharge to acute care that results in the patient's absence from the IRF for longer than 3 calendar days; or • Died while in IRF (Item 44C = [0]); or • Discharged against medical advice (Item 41 = [1]); or • Length of stay is less than 3 days; i.e., Item 40 (Discharge Date) – Item 12 (Admission Date) is less than 3 days. Patient is independent on all mobility activities at the time of the admission:1 • Items used to identify these IRF stays are as follows: Roll left and right (GG0170A1), Sit to lying (GG0170B1), Lying to sitting on side of bed (GG0170C1), Sit to stand (GG0170D1), Chair/bed-to-chair transfer (GG0170E1), Toilet transfer (GG0170F1), Car transfer (GG0170G1), Walk 10 feet (GG0170I1), Walk 50 feet with two turns (GG0170J1), Walk 150 feet (GG0170K1), Walking 10 feet on uneven surfaces (GG0170L1), 1 step (curb) (GG0170M1), 4 steps (GG0170N1), 12 steps (GG0170O1), and Picking up object(GG0170P1). Patient has any of the following medical conditions:2 • Coma, persistent vegetative state, complete tetraplegia, locked-in syndrome, severe anoxic brain damage, cerebral oedema, or compression of brain. Patient is younger than age 18: • Truncate (Item 12 (Admission Date) – Item 6 (BirthDate)). Patient is discharged to hospice: • Item 44D (Discharge destination/Living setting) = [50,51]. 1 The fifteen mobility items listed for this exclusion must = [06] on admission for this exclusion to apply. 2 The medical conditions are identified by: Impairment Group 0004.1221 or 0004.1222 or 0004.2221 or 0004.2222 on Item 21A; or specific ICD-10-CM codes on Item 22 or Item 24.

Yes, risk adjustment covariates. Data for each covariate are derived from the admission data included in the target IRF stays. 1. Age group 2. Admission self-care score – continuous 3. Admission self-care score – squared 4. Primary diagnosis group 5. Interaction between admission self-care and primary diagnosis group 6. Prior acute or IRF primary diagnosis – surgical 7. Prior functioning: self-care 8. Prior functioning: indoor ambulation 9. Prior mobility device/ aids 10. Stage 2 pressure ulcer 11. Stage 3, 4, or unstageable pressure ulcer/injury 12. Cognitive function 13. Communication impairment 14. Bladder incontinence 15. Bowel incontinence 16. Nutritional approaches 17. Low BMI 18. Comorbidities See covariate details in Appendix A, Table A-4 and Table A-5 and the associated Risk Adjustment Appendix File.

Effective on October 1, 2022, the IRF-PAI Version 4.0 is used to collect and submit assessment data for the IRF QRP.

Internet Quality Improvement and Evaluation System (iQIES).

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Measures Information. Accessed August 3, 2023. Available from: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual. Accessed August 3, 2023. Available from: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient rehabilitation facilities - The Measures. Accessed August 3, 2023. Available from: data.cms.gov/provider-data/topics/inpatient-rehabilitation-facilities/measures.

Inpatient Rehabilitation Facility - Quality Reporting Program: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-

Technical specifications: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf

Measures: data.cms.gov/provider-data/topics/inpatient-rehabilitation-facilities/measures

Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)