113 - A comparison of transportation accessibility assessments among Inpatient Rehab Facility (IRF) patients with disability

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

ES

Eleanor J. Sommers, BS

Medical Student
SUNY Upstate Medical University
Manlius, New York, United States
GL

Gracy Lin, BS

Medical student
SUNY Upstate Medical University
Syracuse, New York, United States

Co-Author(s)

ML

Margaret A. Lovier, MPH

Research Fellow
SUNY Upstate Medical University
Syracuse, New York, United States
RJ

Rishita Jessu, DO

Resident Physician
SUNY Upstate Medical University
Syracuse, New York, United States
Katherine D. Goss, MPH

Disability and Health Senior Researcher
SUNY Upstate Medical University
Syracuse, New York, United States
SH

Shernaz K. Hurlong, N/A, DO

Associate Professor PMR
SUNY Upstate Medical University
Syracuse, New York, United States
Margaret A. Turk, MD

Vice-Chairman
SUNY Upstate Department of Physical Medicine & Rehabilitation
Syracuse, New York, United States

Objectives: Patients discharged from IRFs often face new transportation barriers on discharge. The Centers for Medicare and Medicaid Services (CMS) now requires a transportation question for all IRF patients on admission and discharge. The current transportation question does not capture patient transportation barriers for new disabilities as it focuses on prior to admission or past events. The goal of this study was to compare patients' responses to the CMS question with rehabilitation team member assessments of new transportation barriers.

Design: A retrospective chart review was performed on IRF patients admitted with various diagnoses including stroke, spinal cord injury, traumatic brain injury, trauma, and debility. Data was collected on demographics, impairment group, patient reporting of barriers related to new disability, provider assessments, the CMS question, and GG (functional abilities/goals) score.

Results: Sixty-seven consecutively discharged adult IRF patients were included in the retrospective chart review. Transportation barriers were identified by four percent of patients by the CMS question asking about the past year prior to admission. Sixteen percent of patients were aware of new transportation barriers related to their new disability upon discharge from IRF. Sixty-one percent were identified as having a new physical or mental condition that limits cognition. One hundred percent were identified by their provider as requiring new accommodation or adjustment to obtain transportation, were not cleared to drive independently, and required the rehabilitation team to assist with identifying alternate transportation plans due to their new transportation limitation.

Conclusions: Findings show that the current required social determinants of health (SDoH) transportation question greatly underestimated transportation barriers in this sample of IRF patients. Using the CMS question alone is not sufficient in addressing patients’ SDoH and their unique needs with newly acquired disability. Many patients’ transportation needs may be neglected unless CMS modifies the question or unless clinicians document assessment of SDoH.