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Discharge motor FIM-function related groups

M G Stineman1, J E Goin, C V Granger

  • 1University of Pennsylvania Health System, Philadelphia, USA.

Archives of Physical Medicine and Rehabilitation
|September 26, 1997
PubMed
Summary
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A new patient classification system, the Discharge Motor FIM-Function Related Groups (DMF-FRGs), was developed to group rehabilitation patients by functional outcomes. This system aids in outcomes management and quality improvement.

Area of Science:

  • Medical Rehabilitation
  • Health Services Research
  • Outcomes Management

Background:

  • Patient classification is crucial for understanding functional outcomes in medical rehabilitation.
  • Standardized systems are needed to compare patient outcomes across different settings.

Purpose of the Study:

  • To develop a patient classification system to group individuals with similar functional outcome scores at discharge from medical rehabilitation.
  • To create a system that facilitates outcomes management, guideline development, and quality improvement.

Main Methods:

  • A recursive partitioning algorithm and clinical input were used to develop patient groups.
  • The system was validated using a dataset of 84,492 rehabilitation inpatients discharged in 1992.
  • Patients were classified into 20 impairment categories, then into Function Related Groups (FRGs) based on admission motor and cognitive Functional Independence Measure (FIM) scores and age.

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Main Results:

  • The Discharge Motor FIM-Function Related Groups (DMF-FRGs) system comprises 139 patient groups.
  • The system explains 63% of the variation in motor FIM discharge scores within the validation dataset.
  • Examples provided include nontraumatic brain injury and joint replacement patient groups.

Conclusions:

  • The DMF-FRGs enable clinicians to identify patient groups with discharge motor FIM scores outside established national ranges.
  • This classification system supports outcomes management, the development of clinical guidelines, and quality improvement initiatives.
  • The DMF-FRGs may also inform the design of outcome-based payment systems for medical rehabilitation.