Risk-adjusted mean change in self-care 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 self-care score between admission and discharge among Inpatient Rehabilitation Facility (IRF) Medicare patients age 18 or older. The change in self-care score is calculated as the difference between the discharge self-care score and the admission self-care score.* *Admission and discharge functional assessment items included in this measure: GG0130A1, GG0130B1, GG0130C1, GG0130E1, GG0130F1, GG0130G1, GG0130H1, GG0130A3, GG0130B3, GG0130C3, GG0130E3, GG0130F3, GG0130G3, and GG0130H3.

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 self-care activities at the time of admission:1 • Items used to identify these IRF stays are as follows: Eating (Item GG0130A1), Oral hygiene (Item GG0130B1), Toileting hygiene (Item GG0130C1), Shower/Bathe self (Item GG0130E1), Upper body dressing (Item GG0130F1), Lower body dressing (Item GG0130G1), Putting on/taking off footwear (Item GG0130H1). 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 (see Appendix A, Table A-3).

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

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

Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)