| What are outcomes? |
| An outcome is any measurable occurrence between admission and a follow-up
point in time (discharge for our purposes). In Rehabilitation Medicine,
we look at functional performance indicators such as: the Functional Independence
Measure (FIM), Length of Stay (LOS), FIM efficiency (change in FIM per
day), discharge disposition, and payer mix. We also review and measure
certain types of documentation for compliance with different regulations. |
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| Why are outcomes important? |
| It is extremely important for us to be aware of our effectiveness and
efficiency as a rehabilitation facility, from functional and financial
perspectives. Outcomes provide us with concrete measures for both of these.
Also, the Commission on Accreditation of Rehabilitation Facilities (CARF)
standards require us to collect and employ information in a manner that
is useful and that contributes to administrative and clinical decisions.
Information should support current performance improvement initiatives
and identify new areas for discussion. Finally, CARF requires that valid
and reliable information be shared with consumers and other stakeholders. |
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| Who are our stakeholders? |
| A stakeholder is any entity that has a vested interest in the rehabilitation
center’s affairs. This includes, but is not limited to, consumers
(patients), staff, referring physicians and agencies, referring hospitals,
insurance companies, and community and government agencies. |
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| How do we share this information with our
stakeholders? |
| We send out periodic newsletters with outcomes information. The newsletter
is sent to insurance companies, referring hospitals and agencies, as well
as consumers and staff. The Mount Sinai Rehabilitation Center staff attends
periodic in-services presented by the Coordinator for Outcomes Analysis,
who provides outcomes updates as needed. |
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| How do we use outcomes? |
| We use outcomes to support performance improvement initiatives. We also
analyze data and compare ourselves against regional and national averages
(benchmarks) to determine our efficacy relative to other facilities. We
use functional indicators and Length of Stay (LOS) to make programming
changes in order to increase efficiency. |
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| How do we measure outcomes? |
| For functional data, we use the Functional Independence Measure (FIM)
found on the Inpatient Rehabilitation Facility – Patient Assessment
Form (IRF-PAI). We also collect data on length of stay, financial resources,
demographics, and social histories (such as community roles). Checklists
are used for certain types of concrete data. |
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| What are our data collection methods? |
The interdisciplinary team completes the IRF-PAI and the Interdisciplinary
Assessment/Discharge Form (IAF/IDF), which provides much of the information
described above. The PPS Coordinators are responsible for making sure
that the IRF-PAI is completed and coded in a timely manner. The Admissions
Liaison Coordinator also collects demographic and financial information
at the time of admission. PPS Coordinators perform monthly chart reviews
for Medicare patients and share reports with the Performance Improvement
Committee. Management also performs monthly closed chart reviews for
all patients. These reviews allow managers to examine all documentation,
including the IAF/IDF, the IRF-PAI, and the Interdisciplinary Treatment
Plan (ITP), for completeness and consistency.
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| What is the staff’s role? |
The staff is responsible for providing quality care and completing
all documentation on time. This includes:
- All Therapy disciplines and Psychology
- IRF-PAI (FIM)
- IAF/IDF
- ITP
- Education Sheet
- Progress notes including treatment hours
- Nursing
- IRF-PAI (FIM)
- ITP
- Admission Assessment
- Education Sheet
- Discharge Summary
- Physician
- IRF-PAI (coding)
- IAF/IDF (only complete IAF portion)
- ITP
- Disclosure Statement
- Admissions Liaison
- IRF-PAI
- Disclosure Statement
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| What are we looking at currently (March 2003)? |
- LOS—by Case Mix Group (CMG), by payer
- Onset Days—by CMG
- FIM scores and FIM efficiencies (FIM change per each day of LOS)—by
CMG
- Relationships between LOS and onset days and FIM scores
- Disclosure statement: Is it completed correctly?
- Difference between the estimated LOS (ELOS) and actual LOS (ALOS)
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| What do we plan to do with this information? |
- Utilize the information to develop and implement program changes
to increase efficiency and effectiveness
- Provide reports for the Performance Improvement Committee and the
Clinical Affairs Committee
- Meet quarterly with Mount Sinai Rehabilitation Center staff (OT/PT/SLP)
to discuss outcomes and potential areas of improvement
- Share information with all stakeholders through newsletters and other
media
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| What have we done so far as a result of outcomes
management? |
- Advocated (and continue to advocate) for more OT/PT staff on acute
care in order to increase efficiency with rehabilitation referrals
(decreasing onset days)
- Implemented use of a binder on each floor that lists CMG LOS for
all Medicare patients
- Began modifications of the Interdisciplinary Treatment Plan in order
to streamline and standardize the form and the team conference process
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