title: Grading: an annotated "pen and paper" approach to multidimensional case-mix-adjusted continuous quality improvement.
abstract: In this article, we present a simple multidimensional approach to case-mix adjustment that can be used without sophisticated statistical or computer programs. The objectives are to synthesize and offer examples of practical applications of the principles provided in the other articles in this issue of Topics in Stroke Rehabilitation. Combining case-mix adjustment concepts presented by Berlowitz and coworkers with the educate, execute, and evaluate process presented by Needham and coworkers, the approach applies functional grading to show how to evaluate the impact on patient outcomes after major changes in the structural characteristics of an integrated rehabilitation program within a large hospital-based health system. The example is based on the vignette, Maintaining Functional Outcomes in Times of Change, which appears in the article, "Unraveling the Conundrum of Quality" in this issue.
authors.affiliation: Physical Medicine and Rehabilitation and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.forename: Jeremy
authors.initials: J
authors.lastname: Charles
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
mesh_terms: D000203:Activities of Daily Living; D003953:Diagnosis-Related Groups; D006801:Humans; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement / Q000706:statistics & numerical data; D020379:Risk Adjustment / Q000379:methods*; D000071939:Stroke Rehabilitation