Quality indicators prospectively associated with falls in inpatient rehabilitation facilities.

Objective: Retrospective studies suggest quality indicators (QI) are associated with falls in inpatient rehabilitation facilities (IRFs), but this claim has not yet been validated prospectively. The aim of this study was to analyze the associations between QI codes and falls in a prospective sample.

Design: For this prospective observational cohort study, we followed 658 patients from 4 IRFs who were consecutively admitted and discharged over a 6-month period. On admission, we collected patients' QI codes, and then, tracked whether they fell during their IRF stay.

Results: Univariable logistic regressions revealed that most individual QI items for communication, self-care, and mobility were significantly associated with falls. In a multivariable model with 6 different QI items, only patients' performance going up and down 1 step was significantly associated with falls. To explain this finding, we investigated the relationships between these QI items and found 3 of them to be highly correlated.

Conclusions: Most individual QI items appear prospectively associated with falls. Patients with lower QI codes are more likely to fall. Combining QI items (such as expression and toileting) may improve fall-risk assessment, but some QI items may be too interrelated to use together.