Category: Health Policy and Systems
Objectives: Although hospitals and Inpatient Rehabilitation Facilities (IRF) are often considered separate organizations, more than three-quarters of IRFs are hospital-based.1 Hospitals and IRF that share the same setting may benefit from spillover effects of quality; quality in one institution in close proximity may influence quality in the other. In this analysis, we explored the correlation between healthcare quality in hospitals and hospital-based IRF.
Design: Data sources included 2018 IRF Compare, 2018 Hospital Compare, and 2016 American Hospital Association (AHA) Annual Survey. The sample included 882 hospital-based IRF and associated hospitals. We selected 7 IRF Compare measures that had content-concordant hospital measure counterparts and examined the correlation across settings.
Results: Hospital and IRF quality measures were significantly correlated for Clostridium difficile standardized infection ratios (r=0.169, p< 0.001) and IRF discharge-to-community 30-day readmission rates (r=-0.150, p< 0.001), patient influenza vaccination rates (r=0.254, p< 0.001), Medicare spending per beneficiary (MSPB) (r=0.346, p=0.001), and staff influenza vaccination rates (r=0.588, p< 0.001). We found no correlation between IRF and hospital measures related to rates of pressure ulcers or falls.
Conclusions: Although 5 of 7 measures in our analyses demonstrated significant correlations between hospital and IRF settings, most were of low-to-moderate strength, and we found no correlation in the rates of pressure ulcers or falls. From an organizational standpoint, low cross-setting correlations may suggest areas of unexploited complementarities, impedances in internal flows of information and ideas, and potentially unrealized returns to prior investment in quality. Improving knowledge management within institutions may improve internal quality improvement and potentially expedite reporting.