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Related Experiment Videos

An assessment tool translation study.

Joan L Buchanan1, Patricia L Andres, Stephen M Haley

  • 1Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. buchanan@hcp.med.harvard.edu

Health Care Financing Review
|August 5, 2003
PubMed
Summary
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Policymakers attempted to use the Minimum Data Set Post-Acute Care (MDS-PAC) functional assessment in rehabilitation payment systems. Translation issues between MDS-PAC and the Functional Independence Measure (FIM) ultimately halted this initiative.

Area of Science:

  • Health Services Research
  • Rehabilitation Medicine
  • Health Economics

Background:

  • Prospective Payment Systems (PPS) in inpatient rehabilitation rely on functional assessment data.
  • The Functional Independence Measure (FIM) database was integral to the existing Medicare PPS design.
  • A new instrument, the Minimum Data Set Post-Acute Care (MDS-PAC), was considered for substitution.

Purpose of the Study:

  • To describe the translation efforts between MDS-PAC and FIM-like items.
  • To identify challenges encountered during the translation process.
  • To explain the reasons for abandoning the MDS-PAC substitution into the PPS.

Main Methods:

  • Developing a translation methodology from MDS-PAC items to FIM-like items.
  • Assessing the accuracy and feasibility of the item translation.

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  • Evaluating the impact of translation on payment equity.

    • Main Results:

    • Significant challenges were encountered in accurately translating MDS-PAC items to FIM-like equivalents.
    • The translation process revealed substantial difficulties in ensuring payment equity.
    • These obstacles led to the discontinuation of the substitution effort.

    Conclusions:

    • The accurate translation of functional assessment instruments is critical for payment system integrity.
    • Substitution of the MDS-PAC for FIM in the PPS proved unfeasible due to translation complexities.
    • Policymakers abandoned the initiative because of the identified translation problems and equity concerns.