Functional status outcomes in rehabilitation. Implications for prospective payment

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Health Economics

Background:

• Functional status is a key predictor of resource utilization in rehabilitation.
• Implementing a prospective payment system (PPS) requires a conceptual framework for rehabilitation resource use.
• The influence of functional status on rehabilitation outcomes may differ across conditions.

Purpose of the Study:

• To present a theoretical model of rehabilitation resource use.
• To analyze the role of functional status in predicting changes in functional status across nine rehabilitation conditions.
• To identify variables that minimize adverse provider incentives in patient selection for rehabilitation.

Main Methods:

• Development of a theoretical model linking patient/provider characteristics, treatment, costs, and outcomes.
• Regression analyses to predict change in functional status for nine rehabilitation conditions.
• Inclusion of variables designed to mitigate provider selection bias.

Main Results:

• The model explained the most variance in functional status change for back injury, cardiopulmonary, and arthritis.
• Less variance was explained for stroke, spinal cord injury, and neurologic impairment.
• Significant predictors of functional status change varied notably by rehabilitation condition.

Conclusions:

• Results support using functional status measurements within a PPS for rehabilitation services.
• There is a need to refine the measurement of functional status for PPS.
• Condition-specific activities of daily living (ADL) items should be considered for inclusion in summary indices.