Abstract
Objective
To examine how similar summary scores of physical functioning using the FIM can represent
different patient clinical profiles.
Design
Retrospective cohort study.
Setting
Inpatient rehabilitation facilities.
Participants
Medicare fee-for-service beneficiaries (N=765,441) discharged from inpatient rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
We used patients’ scores on items of the FIM to quantify their level of independence
on both self-care and mobility domains. We then identified patients as requiring “no
physical assistance” at discharge from inpatient rehabilitation by using a rule and
score–based approach.
Results
In those patients with FIM self-care and mobility summary scores suggesting no physical
assistance needed, we found that physical assistance was in fact needed frequently
in bathroom-related activities (eg, continence, toilet and tub transfers, hygiene,
clothes management) and with stairs. It was not uncommon for actual performance to
be lower than what may be suggested by a summary score of those domains.
Conclusions
Further research is needed to create clinically meaningful descriptions of summary
scores from combined performances on individual items of physical functioning.
Keywords
List of abbreviations:
CMS (Centers for Medicare and Medicaid Services), IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014), IRF-PAI (Inpatient Rehabilitation Facility – Patient Assessment Instrument), PAC (post–acute care)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Analysis of crosscutting Medicare functional status quality metrics using the Continuity and Assessment Record and Evaluation (CARE) item set—final report.(Available at:) (Accessed February 1, 2017)
Improving Medicare Post-Acute Care Transformation Act of 2014. S. 2553. 2D ed2014.
- Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) training manual.Uniform Data System for Medical Rehabilitation, Buffalo2001
- Medicare Program; Inpatient rehabilitation facility prospective payment system for federal fiscal year 2016. Final Rule. Federal Register.Centers for Medicare & Medicaid Services, Dept of Health and Human Services, Wasington (DC)2016
- A review of stairway falls and stair negotiation: lessons learned and future needs to reduce injury.Gait Posture. 2016; 49: 159-167
- Prediction of institutionalization in the elderly: a systematic review.Age Ageing. 2010; 39: 31-38
- Center for Disease Control and Prevention (CDC) Nonfatal bathroom injuries among persons aged ≥15 years—United States, 2008.MMWR Morb Mortal Wkly Rep. 2011; 60: 729-733
- Circumstances and outcomes of falls among high risk community-dwelling older adults.Inj Epidemiol. 2014; 1
- Ergonomic and safety risk factors in home health care: exploration and assessment of alternative interventions.Work. 2012; 42: 341-353
- Medicare post-acute care reforms.(Available at:)http://medpac.gov/docs/default-source/reports/jun17_ch1.pdf?sfvrsn=0Date accessed: July 2, 2017
Article info
Publication history
Published online: February 08, 2018
Footnotes
Supported in part by the National Institutes of Health (grant nos. R24 HD065702, R01 HD069443) and the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. H133G140127).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
