Discharge motor fim-function related groups

Abstract

Objective: To develop a patient classification system that groups patients achieving similar functional outcome scores by discharge from medical rehabilitation. Design: Patient groups were developed using a recursive partitioning algorithm and clinical input. Results were validated in a separate set of patient records. Setting: Two hundred fifty-two free-standing rehabilitation hospitals and distinct part units that participate in the Uniform Data System for Medical Rehabilitation. Patients: The 84,492 rehabilitation inpatients discharged in 1992 were grouped into 20 impairment categories. Main Outcome Measure: Discharge score on the motor subscale of the Functional Independence Measure (FIM). Results: In the Discharge Motor FIM-Function Related Groups (DMF-FRGs) system, patients are first classified into one of 20 impairment categories and then into FRGs by their admission motor FIM scores. Some FRGs are also subdivided on the basis of admission cognitive FIM scores and age. The entire system consists of 139 patient groups that explain 63% of the variation in motor FIM discharge scores in the validation data set. Nontraumatic brain injury and joint replacement DMF-FRGs are provided as examples. Conclusion: Clinicians can use the DMF-FRGs to identify groups of patients whose motor FIM scores at discharge are below, within, or above nationally established ranges of values for the purpose of outcomes management, guideline development, and quality improvement. The DMF-FRGs can also be considered in the design of an outcome-based payment system for medical rehabilitation.