Maney M; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Miriam Maney, M.A., Decision Support Specialist, Institute for Applied Gerontology, 6323 Seventh Avenue, Brooklyn, New York 11220. Tel: (718) 921-7617; Fax: (718) 630-2565; e-mail mmaney@mjhs.org
Research objective(s): The Balanced Budget Act of 1997 has impacted post-acute care for patients receiving skilled nursing and rehabilitation therapy in a variety of settings including nursing homes, rehabilitation hospitals and the home. In each setting instruments that have been developed independently to address patient progress and reimbursement mechanisms have been applied. Based upon expected increases in networks of integrated services, the analysis of patient progress throughout a continuum of services will be necessary to evaluate outcomes and validate cost-effectiveness. This paper examines the ability to develop a crosswalk and analyze comparable variables from mandated instruments. Study design: Databases from the nursing homes and the home health agency of the Metropolitan Jewish Health System served as data sources. A merged data file was created based on matching identification numbers of patients discharged during 1998 with admitting diagnoses using ICD-9 codes for stroke and orthopedic conditions as the selection criteria. The resulting database consisted of 873 cases and 469 variables drawn from the OASIS, FIM and MDS instruments as well as other data collected by the agencies. (Data will be refreshed with 1999 discharges).Population studied: Patients admitted for skilled nursing and rehabilitation therapy services either in a nursing home or home health settingPrincipal findings: Brief background is provided on the ordinal scales that describe functional (activities of daily living) activities in each instrument, including information on reliability and validity. A crosswalk algorithm is utilized to transform results from each into a common scale. Discussion will address what elements are common to each instrument as well as what is unique or contradictory. After translating the selected variables, the ADL items of the FIM and the MDS items at admission demonstrate a significant correlation. The transition from nursing home to home health is captured by comparing the ADL items of the FIM instrument at discharge with the start of care score of the OASIS subset. In order to look at overall effectiveness of treatment, analysis of patient improvement as a function of length of stay in days and hours of therapy are presented for both the nursing home stay and for home health services.Conclusions: Although effectiveness of treatment in more than 1 setting can be described by building crosswalks between outcomes instruments, differences in the instruments need to be addressed in order to make the crosswalk completely effective. Implications for policy, delivery or practice: Health care organizations continue to move toward developing networks of integrated care and reimbursement may become bundled. Since reimbursement mechanisms of the FIM-FRG, RUGS, and OASIS (HHCG) each rely strongly upon status of the patient in ADL and functional activities, the potential for measuring outcomes across settings effectively would be greatly improved and facilitated by incorporating a uniform ordinal scale to measure patient function. Primary funding source: Institute for Applied Gerontology
Publication Types:
Keywords:
- Activities of Daily Living
- Case-Control Studies
- Data Collection
- Health Services
- Health Services Research
- Humans
- Nursing Homes
- Patient Discharge
- Stroke
- instrumentation
- rehabilitation
- utilization
- hsrmtgs
Other ID:
UI: 102272730
From Meeting Abstracts