Carol F. Russell

The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999.

Deutsch A, Fiedler RC, Granger CV, Russell CF: The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999. Am J Phys Med Rehabil 2002;81:133–142.This is the 10th annual report describing patients discharged from comprehensive medical rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation. The analysis included 298,973 complete records of first admission cases discharged alive from 676 facilities in 1999. The data show that patients receiving care in comprehensive rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

The FIM instrument in the United States and Italy: a comparative study.

Tesio L, Granger CV, Perucca L, Franchignoni FP, Battaglia MA, Russell CF: The FIM™ instrument in the United States and Italy: A comparative study. Am J Phys Med Rehabil 2002;81:168–176. ObjectiveTo compare FIM™ instrument ratings between Italy and the United States. DesignThis study utilized 169,835 United States and 4,536 Italian FIM instrument records for stroke with the left side of the body affected, stroke with the right side of the body affected, and orthopedic conditions. ResultsCase-mix, patient age, and admission and discharge FIM instrument scores were similar. The delays between onset of disability and admission to rehabilitation and lengths of stay in rehabilitation were 2–4 times longer in Italy. In Italy, some 88–95% of the subjects were discharged to the community vs. 74–88% in the United States. Hierarchies of FIM instrument ratings across the motor and cognitive items were similar, but there were interesting differences. The hierarchical patterns showed that dressing, bathing, perineal hygiene, and tub or shower transfer were relatively more difficult in Italy compared with the Unites States, whereas walking was easier in Italy compared to the United States. ConclusionThe Italian health care payment system offers less incentive for early discharges from acute care and rehabilitation. In Italy, nursing homes are less accessible, whereas family support is more available. Apparently less intensive treatment is applied in Italy, where a minimum time per day for rehabilitation services is not mandatory for payment. Occupational therapy is not used in Italy and the focus is more on physical therapy.

Modifications of the FIM instrument under the inpatient rehabilitation facility prospective payment system

Granger CV, Deutsch A, Russell C, Black T, Ottenbacher KJ: Modifications of the FIM instrument under the inpatient rehabilitation facility prospective payment system. Am J Phys Med Rehabil 2007;86:883–892. Objectives:To describe the modifications made to the FIM instrument when it was incorporated into the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and to compare FIM data collected before and after the IRF prospective payment system (IRF-PPS) was implemented in 2002 for patients with stroke. Design:Year-by-year comparison of data of Medicare patients with stroke discharged in 1998–2003 from 411 IRFs that submitted data to the Uniform Data System for Medical Rehabilitation for each of those years. Results:In the pre-PPS period, admission motor FIM ratings decreased slightly, and discharge motor, admission cognitive, and discharge cognitive ratings remained stable. Between 2001 and 2003, all four ratings decreased: admission motor by 1.8 FIM units, discharge motor by 3.3 FIM units, and admission and discharge cognitive each by 1.0 FIM unit. The lower admission FIM ratings led to an increase in the mean case-mix index from 1.39 to 1.49. Conclusions:The decrease in FIM ratings in the IRF-PAI/PPS years may reflect alterations in coding practices as a result of changed rules for rating the FIM instrument, “downcoding” leading to assignment into higher-paying categories, changes in the IRF patient population, and/or changes in IRF patient outcomes. Coding changes should be considered when comparing pre-PPS and PPS FIM data.

The Uniform Data System for Medical Rehabilitation report: patients discharged from subacute rehabilitation programs in 1999.

Deutsch A, Fiedler RC, Iwanenko W, Granger CV, Russell CF: Uniform Data System for Medical Rehabilitation report: Patients discharged from subacute rehabilitation programs in 1999. Am J Phys Med Rehabil 2003;82:703–711. This is the third annual report describing patients discharged from subacute rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation (UDSmr). The analysis included 39,562 complete records of first admission cases discharged alive from 180 facilities in 1999. Sixty-five percent of the patients were women, and most patients (91%) were white. Sixty-two percent of the patients were 75 yr of age or older. Before the impairment onset, 55% lived with at least one other person. The average total FIM™ (motor and cognitive) score change for all patients was 21.1 points, and when stratified by rehabilitation impairment group, average scores ranged from 18.3 for patients with pulmonary conditions to 25.3 for patients with a joint replacement. The percentage of patients discharged to a community-based setting ranged from 67% for patients with stroke to 94% for patients with a joint replacement. These data show that patients receiving care in subacute rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

Apparent Changes in Inpatient Rehabilitation Facility Outcomes Due to a Change in the Definition of Program Interruption

OBJECTIVE To describe changes in inpatient rehabilitation facility (IRF) outcomes due to the program interruption definitional change, from 30 days to 3 days, in 2002. DESIGN Secondary data analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database. SETTING Four hundred eleven IRFs that submitted data to the UDSMR database in each of the years 1998 through 2003. PARTICIPANTS Patient assessment data for 772,584 Medicare fee-for-service beneficiaries. INTERVENTIONS None. MAIN OUTCOME MEASURES The number of IRF patient discharges, percent of IRF patients discharged to the community, percent of IRF patients discharged to acute care, percent of IRF patients with program interruptions, percent of IRF inpatient deaths, and average IRF length of stay (LOS). RESULTS IRF outcomes appeared to change because of the program interruption redefinition, with changes varying by impairment group. The largest changes due to the redefinition occurred for patients with traumatic spinal cord injury, including the largest percentage increase in patients (5.16%), the largest decrease in program interruptions (5.14%), the largest increase in acute care discharges (5.04%), and the largest mean decrease in LOS (1.27d). Community discharge showed the largest decrease for patients with Guillain-Barré syndrome (4.03%). CONCLUSION The change in the definition of program interruptions creates the appearance of changes in IRF performance and is important to consider when comparing the preprospective payment system (PPS) and PPS assessment data.

Outpatients with low back pain: An analysis of the rate per day of pain improvement that may be expected and factors affecting improvement

Granger CV, Lackner JM, Kulas M, Russell CF: Outpatients with low back pain: An analysis of the rate per day of pain improvement that may be expected and factors affecting improvement. Am J Phys Med Rehabil 2003;82:253–260. Objective To determine, only for those who improved, the rate per day of improvement expected for outpatients with low back pain and to identify factors influencing pain improvement: pain duration before assessment, pain and physical functioning levels before assessment, age, sex, and affective factors. It was presupposed that affective factors would have an appreciable effect. Design The LIFEware SystemSM database was used. Analysis was performed on 1292 records for the Painfree measure and 1562 records for the LIFEware System Visual Analog Scale. Measures for pain, physical functioning, and affective well-being were analyzed for 0–30 days vs. >30 days of pain duration before assessment using classification and regression trees analysis. Results In both Painfree and LIFEware System Visual Analog Scale, 73% improved and 27% did not improve. Of those who improved, outpatients with 0–30 days of pain duration before assessment had higher per day rates of improvement than the >30 days group. Factors affecting improvement were, in descending order, more initial pain, younger age, and positive affective well-being; physical functioning did not affect rate of improvement. Factors affecting improvement for outpatients with >30 days since onset were, in descending order, more initial pain and better initial physical functioning; age and affective well-being were not factors. For all, neither sex nor the “satisfaction with life in general” question affected low back pain rate of improvement. Conclusion Findings may be useful for clinical application because the actual rate of improvement may be compared with the expected rate. There was only a weak relationship shown between affective factors and pain improvement.