Skip to Content

R1: Recovery of Function Across Rehabilitation Settings: An Equating and Effectiveness Study

Overview

Why is this study needed?

The use of different evaluation instruments in Post Acute Care (PAC) settings makes it impossible to compare functional outcomes across these health care delivery channels. Medicare mandates the use of these instruments as they are the basis of the payment systems. As a result, it is difficult to replace these instruments, or change their use. Given this reality, this study will use modern test equating procedures to equate patient scores across each instrument, enabling comparison of patient function across PAC settings. Developing this type of approach will enable meaningful comparisons across settings while building upon the substantial investments in tool development, staff training and payment system implementation that has occurred to date.

How will this study help patients and rehabilitation stakeholders?

This study will provide information about the effectiveness and cost-effectiveness of rehabilitation care provided in a range of post-acute care settings.

What are the project objectives?

  • Objective 1:
    Equate the motor and cognition scales of the MDS, OASIS and FIM on 600 patients with stroke, hip fracture and hip replacement.
  • Objective 2:
    Apply the equating results of Objective 1 to all Medicare beneficiaries with stroke, hip fracture, hip replacement receiving rehabilitation in Home Health Agencies (HHA), Inpatient Rehabilitation Facilities (IRF), and Skilled Nursing Facilities (SNF) settings.
  • Objective 3:
    Compare the effectiveness of rehabilitation provided in HHA, IRF and SNF settings with respect to functional gain during an episode of rehabilitative care.

How will the project objectives be achieved?

Primary data collection of all three tools on patients with stroke, hip fracture or hip replacement, in each of the three PAC settings (600 patients total, each rated on all tools) will be used to create a crosswalk across the data collection tools. We will use national Medicare calendar year 2004 data to describe and compare functional scores across PAC settings at admission and discharge for each diagnosis and will also be able to compare the change in functional scores across settings for different diagnoses and patient characteristics. We will then predict functional gain and cost as a function of patient characteristics and PAC setting using Medicare data for PAC rehabilitation admissions in 2004. In these analyses, we will be able to control for all patient characteristics that are collected by Medicare across all PAC settings. This will allow us to have a valid picture of the strengths and weaknesses of using Medicare data to predict outcomes across PAC settings.

What agency funded the project?

National Institute of Disability and Rehabilitation Research (NIDRR)

NIDDR Grant Number: H133B040032

What is the duration of the project?

December 1, 2004 - November 30, 2009

Project Staff

Principal Investigator:

Trudy Mallinson, Ph.D., Rehabilitation Institute of Chicago

Co- Investigator:

Anne Deutsch, Ph.D., Rehabilitation Institute of Chicago
Deborah Dobrez, Ph.D., University of Illinois at Chicago
Larry Manheim, Ph.D., Northwestern University

Project Manager:

Jillian Bateman, OTD, OTR/L, Rehabilitation Institute of Chicago

Related Project Research Web Sites

National Institute of Disability and Rehabilitation Research (NIDRR)
National Rehabilitation Information Center (NARIC)

Contact Information

For researchers and students
Trudy Mallinson, Ph,D.
312-238-1623

For members of the media
312-238-6044