Can administrative claim file review be used to gather physical therapy, occupational therapy, and psychology payment data and functional independence measure scores? Implications for rehabilitation providers in the private health sector.
OBJECTIVE
Rehabilitation costs for spinal-cord injury (SCI) are increasingly borne by Canada's private health system. Because of poor outcomes, payers are questioning the value of their expenditures, but there is a paucity of data informing analysis of rehabilitation costs and outcomes. This study evaluated the feasibility of using administrative claim file review to extract rehabilitation payment data and functional status for a sample of persons with work-related SCI.


METHODS
Researchers reviewed 28 administrative e-claim files for persons who sustained a work-related SCI between 1996 and 2000. Payment data were extracted for physical therapy (PT), occupational therapy (OT), and psychology services. Functional Independence Measure (FIM) scores were targeted as a surrogate measure for functional outcome. Feasibility was tested using an existing approach for evaluating health services data.


RESULTS
The process of administrative e-claim file review was not practical for extraction of the targeted data.


CONCLUSIONS
While administrative claim files contain some rehabilitation payment and outcome data, in their present form the data are not suitable to inform rehabilitation services research. A new strategy to standardize collection, recording, and sharing of data in the rehabilitation industry should be explored as a means of promoting best practices.
Viivi Riis, MSc, BScPT:  Lecturer, Department of Physical Therapy, University of Toronto, Toronto, Ontario; President, Health Service Management, Collingwood, Ontario.
Viivi
V
Riis
Susan
S
Jaglal
Kathryn
K
Boschen
Jan
J
Walker
Molly
M
Verrier
D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D012046:Rehabilitation; D013119:Spinal Cord Injuries