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The self-reported functional measure: Predictive validity for health care utilization in multiple sclerosis and
1Physical Medical and Rehabilitation Service, Health Services Research and Development Field Program, Durham Veterans Administration Medical Center, Durham, NC, USA. hoeni001@acpub.duke.edu
Objective:
To examine the predictive validity of the Self-Reported Functional Measure (SRFM), a new measure derived from the FIMtrade mark instrument, for health care utilization in multiple sclerosis (MS) and spinal cord injury (SCI).
Design:
Prospective cohort study using a mailed survey in 1995 and administrative records from 1996 and 1997.
Setting:
Veterans Health Administration hospitals and outpatient clinics.
Patients:
A total of 6361 veterans with SCI and 1789 veterans with MS.
Main Outcome Measures:
SRFM score was compared with subsequent outpatient visits, hospitalizations, hospital lengths of stay (LOSs), and residence peri-hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for these variables.
Results:
A total of 3836 subjects (47.6%) were hospitalized during 1996-1997, and all but 874 (10.7%) had 1 or more outpatient visits. SRFM score predicted inpatient, but not outpatient health care utilization. Persons in the lowest SRFM quartile were over 90% (OR = 1.91, 95% CI = 1.71-2.13) more likely to be hospitalized compared with those in the highest SRFM quartile; also, they were over 2 times (OR = 2.18, 95% CI = 1.85-2.57) more likely to have a LOS greater than 7 days, were over 2 times (OR = 2.41, 95% CI = 1.62-3.58) more likely to die in hospital, and were nearly 3 times (OR = 2.86, 95% CI = 2.00-4.08) more likely to be discharged to an institution.
Conclusions:
SRFM had excellent predictive validity for hospitalization, LOS, and discharge destination among patients with MS or SCI.