title: Benchmarking Outpatient Rehabilitation Clinics Using Functional Status Outcomes.
abstract: OBJECTIVE
  To utilize functional status (FS) outcomes to benchmark outpatient therapy clinics.
  
  
  METHODS
  Outpatient therapy data from clinics using Focus on Therapeutic Outcomes (FOTO) assessments.
  
  
  METHODS
  Retrospective analysis of 538 clinics, involving 2,040 therapists and 90,392 patients admitted July 2006-June 2008. FS at discharge was modeled using hierarchical regression methods with patients nested within therapists within clinics. Separate models were estimated for all patients, for those with lumbar, and for those with shoulder impairments. All models risk-adjusted for intake FS, age, gender, onset, surgery count, functional comorbidity index, fear-avoidance level, and payer type. Inverse probability weighting adjusted for censoring.
  
  
  METHODS
  Functional status was captured using computer adaptive testing at intake and at discharge.
  
  
  RESULTS
  Clinic and therapist effects explained 11.6 percent of variation in FS. Clinics ranked in the lowest quartile had significantly different outcomes than those in the highest quartile (p < .01). Clinics ranked similarly in lumbar and shoulder impairments (correlation = 0.54), but some clinics ranked in the highest quintile for one condition and in the lowest for the other.
  
  
  CONCLUSIONS
  Benchmarking models based on validated FS measures clearly separated high-quality from low-quality clinics, and they could be used to inform value-based-payment policies.
authors.affiliation: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI.|Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Gozalo
authors.affiliation: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI.|Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.|Providence Veterans Administration Medical Center, Health Services Research, Providence, RI.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Resnik
authors.affiliation: Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Silver
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000592:standards*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards*; D026741:Physical Therapy Modalities / Q000592:standards*; D011787:Quality of Health Care; D012047:Rehabilitation Centers / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult
keywords: Rehabilitation; bench-marking; physical therapy; profiling; quality measurement