The Balanced Budget Act of 1997 has impacted post-acute care for patients receiving skilled nursing and rehabilitation therapy in a variety of settings including nursing homes, rehabilitation hospitals and the home. In each setting instruments that have been developed independently to address patient progress and reimbursement mechanisms have been applied. Health care organizations continue to move toward developing networks of integrated care. Since reimbursement mechanisms of the FIM-FRG, RUGS, and OASIS (HHCG) each rely strongly upon status of the patient in ADL and functional activities, a case study in the potential for measuring outcomes across settings is presented. Databases on 873 stroke and orthopedic patients from the nursing homes and the home health agency of the Metropolitan Jewish Health System served as data sources. A merged data file was created consisting of 469 variables drawn from the OASIS, FIM and MDS instruments as well as other agency data. Reliability and validity information is provided on the ordinal scales that describe functional (activities of daily living) activities in each instrument. In order to look at overall effectiveness of treatment, analysis of patient improvement as a function of length of stay in days and hours of therapy are presented for both the nursing home stay and for home health services. Although effectiveness of treatment in more than 1 setting can be described by building crosswalks between outcomes instruments, differences in the instruments need to be addressed if outcomes across settings of care are to be measured in a bundled reimbursement system.
Learning Objectives: 1. Participants will become familiar with reliability and validity of these instruments, MDS, FIM and OASIS 2. Participants will gain an understanding of the measures or patient activities which are common to the instruments as well as the differences in the scoring system
Keywords: Balanced Budget Act, Evaluation
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Institute for Applied Gerontology
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employer