Buchanan Joan L, Andres Patricia L, Haley Stephen M, Paddock Susan M, Zaslavsky Alan M
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
Med Care. 2004 Feb;42(2):155-63. doi: 10.1097/01.mlr.0000108745.40491.01.
The objective of this study was to evaluate the payment implications of substituting the Minimum Data Set-Post Acute Care (MDS-PAC) for the FIM trade mark instrument for use in the planned prospective payment system (PPS) for inpatient rehabilitation hospitals. FIM trade mark is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activites, Inc.
We used a prospective cross-sectional design using consecutive sampling.
We studied all Medicare admissions with stays of 3 days or more over a 2-month period to 50 inpatient rehabilitation hospitals in 22 states.
Each participating institution completed both the FIM and the MDS-PAC assessments on all participants. Items from the MDS-PAC were combined and translated to create "FIM-like" items. We assessed agreement of classification into prospective payment cells using FIM assessment data and also using MDS-PAC data. Statistical adjustments were applied to improve the level of agreement.
The mean differences between the FIM motor and cognitive scales and their MDS-PAC translations were 2.4 (mean = 45) and 0.0 (mean = 28), respectively, with scale correlations of.85 and.84. Weighted kappas on individual items ranged from.32 to.64. There were substantial hospital-specific differences in scoring. Payment cell classification using FIM data agreed with that using MDS-PAC data only 56% of the time. Twenty percent of the facilities experienced revenue shifts larger than 10%.
Despite better item-level agreement than previously observed, poor payment cell agreement and substantial revenue shifts indicated that the MDS-PAC should not be substituted for the FIM trade mark instrument in the rehabilitation hospital PPS.
本研究的目的是评估在计划中的住院康复医院前瞻性支付系统（PPS）中，用最低数据集-急性后护理（MDS-PAC）替代FIM商标工具所产生的支付影响。FIM商标是医学康复统一数据系统的商标，该系统是UB基金会活动公司的一个部门。
我们采用前瞻性横断面设计，通过连续抽样进行研究。
我们研究了22个州50家住院康复医院在两个月内所有住院时间达3天或更长时间的医疗保险入院病例。
每个参与机构对所有参与者同时完成FIM和MDS-PAC评估。将MDS-PAC中的项目进行合并和翻译，以创建“类似FIM”的项目。我们使用FIM评估数据以及MDS-PAC数据评估前瞻性支付单元分类的一致性。应用统计调整来提高一致性水平。
FIM运动量表和认知量表与其MDS-PAC翻译之间的平均差异分别为2.4（均值 = 45）和0.0（均值 = 28），量表相关性分别为0.85和0.84。单个项目的加权卡帕值范围为0.32至0.64。评分存在显著的医院特异性差异。使用FIM数据进行的支付单元分类与使用MDS-PAC数据的分类仅在56%的情况下一致。20%的机构收入变化超过10%。
尽管项目层面的一致性比之前观察到的更好，但支付单元一致性差和收入大幅变化表明，在康复医院PPS中，MDS-PAC不应替代FIM商标工具。
