title: The effect of inaccurate FIM instrument ratings on prospective payment: a study of clinician expertise and FIM rating difficulty as contributing to inaccuracy.
abstract: OBJECTIVE
  To test whether clinician expertise and FIM instrument rating difficulty explain clinician overconfidence in FIM rating accuracy.
  
  
  METHODS
  Participants answered 60 true/false FIM questions and, for each question, completed a 6-category scale to assess confidence in the accuracy of their responses. Experts and novices, as well as hard and easy items, were identified through a Rasch analysis. The relation between confidence and accuracy was examined for these different groups.
  
  
  METHODS
  Three urban medical centers.
  
  
  METHODS
  Fifty medical rehabilitation professionals, including physical therapists, occupational therapists, rehabilitation psychologists, speech pathologists, and rehabilitation nurses.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Observed proportion of correct responses to 60 true/false questions and responses from the 6-category confidence scale.
  
  
  RESULTS
  The amount of overconfidence was mediated by the difficulty of the FIM task and the level of expertise of the clinical judge.
  
  
  CONCLUSIONS
  Decreasing the level of overconfidence in FIM scoring is a promising avenue for improving the accuracy of functional assessment. Accurate assessment of functional status for case-mix group classification will be of even greater importance under the recently initiated Medicare prospective payment system.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine Seattle, WA 98195-7240, USA. jdoctor@u.washington.edu
authors.forename: Jason N
authors.initials: JN
authors.lastname: Doctor
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Wolfson
authors.forename: Patrick
authors.initials: P
authors.lastname: McKnight
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D002983:Clinical Competence; D003953:Diagnosis-Related Groups / Q000145:classification*; D006233:Persons with Disabilities / Q000145:classification / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009788:Occupational Therapy; D017063:Outcome Assessment, Health Care / Q000191:economics; D026761:Physical Therapy Specialty; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D011584:Psychology; D019145:Rehabilitation Nursing; D020379:Risk Adjustment; D013066:Speech-Language Pathology; D014481:United States