Comparison of Functional Status Tools Used in Post-Acute Care

By Jette, Alan M.; Haley, Stephen M. et al. | Health Care Financing Review, Spring 2003 | Go to article overview

Comparison of Functional Status Tools Used in Post-Acute Care


Jette, Alan M., Haley, Stephen M., Ni, Pengsheng, Health Care Financing Review


INTRODUCTION

A fundamental barrier to fulfilling the emerging health policy mandate in the United States for monitoring the quality and outcomes of PAC is the absence of standardized, patient-centered outcome data that can provide policy officials and managers with outcome data across different diagnostic categories, over time, and across different settings where PAC services are provided (Wilkerson and Johnston, 1997). Recently, the National Committee on Vital and Health Statistics (NCVHS) (2002) made recommendations on the potential for standardizing data collection and reporting for the purposes of quality assurance as well as for setting future research and health policy priorities in the U.S. The NCVHS (2002) was unanimous in stressing two major goals: "... to put functional status solidly on the radar screens of those responsible for health information policy, and to begin laying the groundwork for greater use of functional status information in and beyond clinical care ..." The NCVHS project used the term functional status very broadly to cover both the individual's ability to carry out activities of daily living (ADLs) and the individual's participation in various life situations and society.

Within PAC, functional outcome instruments have been developed and are widely used for various applications and for use in specific settings. Examples include the functional independence measure (FIM[TM]) for acute medical rehabilitation (Guide for the Uniform Data Set for Medical Rehabilitation, 1997; Hamilton, Granger, and Sherwin, 1987), the minimum data set (MDS) for skilled nursing and subacute rehabilitation programs (Morris, Murphy, and Nonemaker, 1995), the Outcome and Assessment Information Set for Home Health Care (OASIS) (Shaughnessy, Crisler, and Schlenker, 1997) and the Short Form-36 (SF-36) for ambulatory care programs (Ware and Kosiniski, 2001). If one looks carefully at the content of these instruments, it becomes apparent that substantial variations exist in item definitions, scoring, metrics, and content coverage, resulting in fragmentation in outcome data available for use across different PAC settings (Haley and Langmuir, 2000). Differences in conceptual frameworks used to construct each instrument, the inability to translate scores from one instrument to another, and the lack of outcome coverage and precision to detect meaningful functional changes across settings, severely limit the field's ability to measure and analyze recovery through the period of PAC service provision. If the PAC field is to achieve the goal of comprehensive functional outcome assessment and quality monitoring for different patient diagnostic groups across different PAC settings, efforts are needed to develop functional outcome assessments that are applicable across a continuum of post-acute services and settings.

To our knowledge, no studies exist that have directly compared the content and operating characteristics of functional outcome instruments commonly used in PAC to examine their relative merits for monitoring outcomes across care settings. In this article, therefore, we report the results of a direct empirical comparison of the FIM[TM], OASIS, MDS, and the physical function scale (PF-10) of the SF-36, focusing on three aspects of each: instrument content, range of coverage, and measurement precision. The objective of this comparative analysis is to evaluate the commonly held assumption that there exist fundamental deficiencies in the current armamentarium of setting-specific outcome instruments that prevents their applicability for more comprehensive patient-centered functional outcome assessment across diagnoses, over time, and across different settings where PAC is provided. In response to identified deficiencies in existing instruments, we also discuss the potential utility of contemporary measurement techniques, such as item response theory (IRT) methods and computerized adaptive technology (CAT), to yield functional outcome instruments better suited for outcome monitoring across PAC settings. …

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