Discharge motor FIM-function related groups.
OBJECTIVE
To develop a patient classification system that groups patients achieving similar functional outcome scores by discharge from medical rehabilitation.


METHODS
Patient groups were developed using a recursive partitioning algorithm and clinical input. Results were validated in a separate set of patient records.


METHODS
Two hundred fifty-two free-standing rehabilitation hospitals and distinct part units that participate in the Uniform Data System for Medical Rehabilitation.


METHODS
The 84,492 rehabilitation inpatients discharged in 1992 were grouped into 20 impairment categories.


METHODS
Discharge score on the motor subscale of the Functional Independence Measure (FIM).


RESULTS
In the Discharge Motor FIM-Function Related Groups (DMF-FRGs) system, patients are first classified into one of 20 impairment categories and then into FRGs by their admission motor FIM scores. Some FRGs are also subdivided on the basis of admission cognitive FIM scores and age. The entire system consists of 139 patient groups that explain 63% of the variation in motor FIM discharge scores in the validation data set. Nontraumatic brain injury and joint replacement DMF-FRGs are provided as examples.


CONCLUSIONS
Clinicians can use the DMF-FRGs to identify groups of patients whose motor FIM scores at discharge are below, within, or above nationally established ranges of values for the purpose of outcomes management, guideline development, and quality improvement. The DMF-FRGs can also be considered in the design of an outcome-based payment system for medical rehabilitation.
Stineman
M G
MG
University of Pennsylvania Health System, Philadelphia, USA.
Goin
J E
JE
Granger
C V
CV
Fiedler
R
R
Williams
S V
SV
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D003953:Diagnosis-Related Groups / Q000145:classification*; D017598:Efficiency, Organizational; D006801:Humans; D007297:Inpatients / Q000145:classification*; D008875:Middle Aged; D009048:Motor Skills; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011445:Prospective Payment System; D012046:Rehabilitation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017432:Unified Medical Language System