rehabilitation of stroke patient

1. QUALITY AND OUTCOME
MEASURES FOR MEDICAL
REHABILITATION

2. Rehabilitation Quality Outcome
Measures
 Traditional outcome measures focus on
functional ability.
 Attempt is to maximize patients' function
after a traumatic injury or other medical
condition.
 FIM instrument is core outcome instruments
in rehabilitation medicine.
 FIM is an assessment tool ,also used in
payment systems.

3.  FIM focuses on the patient's actual outcome,
rather than just measuring a process step.
so, it could serve as the basis for improved
performance measurement.
The Systems has developed for monitoring patient
gains and basic functional activities, these
systems will be translated into performance
measures, which can be used to evaluate the
work of specific rehabilitation physicians or
hospitals.

4.  FIM is composed of 18 items (13 motor, 5 cognitive)
and uses a seven-level ordinal scale to measure
major gradations of function.
 FIM documents the need for assistance from
another person, a device,and the amount of time
needed to complete the task.
 Functional status at admission and discharge is
assessed by the FIM.
 FIM is used by inpatient rehabilitation hospitals &
monitor progress from admission through
discharge and follow-up.

7. Analyzing Data to Improve
Quality
 analytical services assist clients in achieving
quality improvement by providing data
management, benchmarking, and data trending
 two organizations serving the data submission
and analysis:
 e-Rehab Data
 the UDSMR,which analyses FIM,& by testing
every 2 years maintain data reliability.

8. Data Management
 To evaluate a rehabilitation program: facility
examines total FIM ratings, change from admission
to discharge, length of stay, length of stay
efficiency (change in FIM ratings per day),
discharge FIM ratings total, onset , and discharge
destination.
 During rehabilitation,data are used to enhance
communication among interdisciplinary team
members,patients, and families.
 data can be used as a communication tool to
referral sources and payers, and for internal and
external marketing.

9. Data Management
 data can be used for accreditation processes of
The Joint Commission and Commission on
Accreditation of Rehabilitation Facilities
(CARF).

10. e-Rehab Data
 is a full-service acute rehabilitation outcomes system,
provides real-time access to patient assessment and
outcomes instruments.
 provision of timely, inexpensive, accurate, and
responsive analysis of clinical and financial patient
data.
 accommodate different kinds of rehabilitation
providers.
 meet all the requirements of the CARF,The Joint
Commission and IRF-PPS (Medicare Inpatient
Rehabilitation Facilities Prospective Payment System )

11. e-Rehab Data
 accepts IRF-PAI (Inpatient Rehabilitation Facility-
Patient Assessment Instrument )for both Medicare
and non-Medicare patients.
 Provides capacities for preadmission and follow-up
assessments.

12. The Uniform Data System for
Medical Rehabilitation (UDSMR)
 most widely used database for inpatient rehab. data
with more than 18 million patient assessments.
 collects data on social demographics, medical
diagnoses, and functional status.
 owns the :
 FIM System, the UDS- PRO System, theWeeFIM II
System, and the LIFEware System.
 document the severity of patient disability and the
results of medical rehabilitation in a uniform way.

13. The UDS-PRO System
 comprehensive tool that combines patient
assessment and outcomes management functionality
with reimbursement(kickback).
 combines the IRF-PAI, case-mix groups
assignment,and data transmission to both the CMS
and UDSMR.
 includes both Medicare and non-Medicare
requirements, allowing facilities to evaluate care and
manage resources with one instrument.
 UDSMR supports a UDS-PRO Central website that
contains on-demand reports.
 On-demand reports is a very powerful tool that assist
facilities in identifying strengths in their programs and
areas for improvement.

14. TheWeeFIM II System
 a pediatric-specific outcomes measurement tool with
a developmental framework.
 aged 6 months to 7 years,& older than 7 years if delays
in functional development.
 both the inpatient and outpatient settings.
 allowing rehabilitation facilities to benchmark with
other subscribing facilities across the nation.
 not specific enough for children younger than 3
years.so, the 0-3 Module was developed to be used in
addition to theWeeFIM II instrument,which is filled
out by the child's family members.

15. The LlFEware System
 Internet-based system created for tracking outcomes for a
diverse range of outpatient populations, with impairments
such as: musculoskeletal , neurologic , memory ,
cardiopulmonary , pain , and joint-specific conditions.
 Measures across seven core functional domains: physical
function, cognitive function, mood or affect, pain, social
interaction, role participation, and satisfaction with
treatment.
 It supports medical necessity documentation compliance,
helps substantiate ongoing patient treatment with payers,
includes measures to support compliance with the
Physician Quality Reporting Initiative, provides a reliable
and economic outcomes management system for
outpatient programs.