Characteristics of effective and efficient rehabilitation programs.
OBJECTIVE
To investigate the characteristics of rehabilitation hospitals and units correlated with gains in motor and cognitive function, after adjusting for case severity of the patients admitted and for length of stay (LOS).


METHODS
The Uniform Data System for Medical Rehabilitation (UDSMR) database was first analyzed to develop a method of adjusting for patient case severity on admission. Rehabilitation programs were surveyed to assess characteristics commonly thought to be associated with efficiency and effectiveness. Data on these characteristics were linked to UDSMR data on patient characteristics and functional gain.


METHODS
Seventy-seven rehabilitation hospitals across the United States.


METHODS
A total of 37,692 inpatients from the participating rehabilitation hospitals.


METHODS
Comprehensive rehabilitation programs not altered by researcher.


METHODS
Program effectiveness was estimated by gains in motor and cognitive subscale scores of the FIM trade mark instrument between admission and discharge, adjusted for indicators of caseload severity at admission. Efficiency was estimated by adjusting gains for LOS as well.


RESULTS
Primary factors affecting both motor and cognitive gains included admission function (treated curvilinearly), age, certain diagnostic distinctions, onset-admission interval, admission class, and LOS. Correlations between staffing intensity and numerous other program characteristics with functional gain were meager, each accounting for less than 2% of variance. LOS was predicted by a number of factors, notably by the percentage of managed care cases (r=-.20), but not by staffing intensity.


CONCLUSIONS
Relationships between rehabilitation practices and functional gains by patients do not appear to be simple or overt. Continued research is needed to identify reliable connections between rehabilitative processes and patient outcomes in practice.
Johnston
Mark V
MV
Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ 07072, USA. mjohnston@kmrrec.org
Wood
Kenneth D
KD
Fiedler
Roger
R
D000368:Aged; D001927:Brain Diseases / Q000534:rehabilitation; D017598:Efficiency, Organizational; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D015397:Program Evaluation; D020127:Recovery of Function; D012044:Regression Analysis; D012046:Rehabilitation / Q000592:standards*; D012047:Rehabilitation Centers / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000534:rehabilitation; D014481:United States; D000078329:Workforce