Eilertsen T B, Kramer A M, Schlenker R E, Hrincevich C A
University of Colorado Health Sciences Center, Center on Aging Research Section, Denver 80206, USA.
Med Care. 1998 May;36(5):695-705. doi: 10.1097/00005650-199805000-00009.
The present study evaluated alternative patient classification systems for skilled nursing facility and rehabilitation facility patients.
Medicare patients were selected from a random sample of 27 rehabilitation facilities and 65 skilled nursing facilities participating in a national longitudinal study of subacute care. Detailed casemix and resource use data was obtained on 513 patients with hip fracture and 483 stroke patients. The Functional Independence Measure-Function Related Groups (FIM-FRGs) classification system for rehabilitation facilities was replicated on length of stay and tested on resource use for rehabilitation facility patients as well as for skilled nursing facility patients. Modifications to the FIM-FRGs also were tested. The Resource Utilization Groups-Version III classification was tested on rehabilitation facility patients.
The FIM-FRGs explained the same amount of variance in length of stay as in the original FIM-FRGs development sample (R2 hip fracture = 0.14, R2 stroke = 0.28), and similar variance in resource use. A modified version of the FIM-FRGs explained more variance in length of stay (R2 hip fracture = 0.19, R2 stroke = 0.39) and resource use (R2 hip fracture = 0.20, R2 stroke = 0.41). Neither model adequately predicted length of stay or resource use in skilled nursing facility patients. The Resource Utilization Groups-Version III rehabilitation groups accounted for little variance in rehabilitation facility patients' per-diem resource use (R2 = 0.11).
The FIM-FRGs are valid for resource use as well as length of stay for rehabilitation facility patients, but are not valid for skilled nursing facility patients. Similarly, the Resource Utilization Groups-Version III system does not apply to rehabilitation facility patients. Related work, however, suggests that development of a single episode-based patient classification system for skilled nursing facility and rehabilitation facility patients is possible and should be pursued.
本研究评估了适用于专业护理机构和康复机构患者的替代患者分类系统。
从参与全国亚急性护理纵向研究的27家康复机构和65家专业护理机构的随机样本中选取医疗保险患者。获取了513例髋部骨折患者和483例中风患者的详细病例组合和资源使用数据。康复机构的功能独立性测量-功能相关组（FIM-FRGs）分类系统在住院时间上进行了复制，并在康复机构患者以及专业护理机构患者的资源使用情况上进行了测试。还对FIM-FRGs进行了修改测试。资源利用组第三版分类在康复机构患者中进行了测试。
FIM-FRGs在住院时间上解释的方差量与原始FIM-FRGs开发样本相同（髋部骨折R2 = 0.14，中风R2 = 0.28），在资源使用方面的方差也相似。FIM-FRGs的修改版在住院时间（髋部骨折R2 = 0.19，中风R2 = 0.39）和资源使用（髋部骨折R2 = 0.20，中风R2 = 0.41）方面解释了更多方差。两种模型都不能充分预测专业护理机构患者的住院时间或资源使用情况。资源利用组第三版康复组在康复机构患者每日资源使用方面解释的方差很小（R2 = 0.11）。
FIM-FRGs对于康复机构患者的资源使用和住院时间是有效的，但对专业护理机构患者无效。同样，资源利用组第三版系统不适用于康复机构患者。然而，相关工作表明，为专业护理机构和康复机构患者开发一个基于单一病程的患者分类系统是可能的，应该加以推进。
