Characterizing Standardized Functional Data at Inpatient Rehabilitation Facilities.

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Medical Informatics

Background:

• The Improving Medicare Post-Acute Care Transformation Act of 2014 requires standardized functional data across post-acute care settings.
• This necessitates understanding the comparability of different functional assessment tools.

Purpose of the Study:

• To compare clinician-observed scores for section GG self-care and transfer items with the Functional Independence Measure (FIM) in inpatient rehabilitation.
• To identify similarities and differences in these functional domains.

Main Methods:

• Secondary analysis of 2017 Uniform Data System for Medical Rehabilitation national data.
• Comparison of 7 self-care and 6 transfer items between section GG and FIM using score distributions, Bland-Altman plots, correlation, and agreement analyses.
• Inclusion of 408,491 patients with diverse impairments (stroke, neurologic, orthopedic, etc.).

Main Results:

• Patients were scored as more functionally independent in section GG than FIM.
• Strong positive correlations were found between total section GG and FIM scores (self-care: r=0.87-0.95; transfer: r=0.82-0.90).
• Weak to moderate ranking agreements were observed (self-care kappa=0.49-0.60; transfer kappa=0.43-0.52), with lower agreement for less able patients.

Conclusions:

• Section GG and FIM demonstrate similar response patterns across patient impairments but exhibit variations in score distributions and ranking agreement.
• These findings highlight the need for further examination of section GG code utility.
• Optimizing the use of GG codes is crucial for maintaining effective care, outcomes, and unbiased reimbursement in post-acute settings.