Risk adjustment in rehabilitation quality improvement.

Risk adjustment is an important tool for examining quality and outcomes of care. Considerable work has been accomplished in developing and applying risk adjustment to a variety of health care settings. The knowledge gained from these experiences is increasingly available to help guide clinicians, managers, and policy makers in the area of stroke rehabilitation. Key issues include understanding the purpose of risk adjustment, the unique population being examined, and the specific outcomes of interest. Risk adjustment should also be based on models that have good statistical properties and also make sense to clinicians working in the field. Risk-adjustment systems such as the FIM™- function-related groups (FIM-FRGs) are now being used to monitor the quality of stroke rehabilitation. A specific application of this risk-adjustment system is demonstrated.