An analysis of 9,400 patients transferred from an acute care hospital to an inpatient rehabilitation facility revealed that a standard test of functional abilities was a good predictor of which patients might need to be readmitted to the hospital within 30 days.
The Functional Independence Measure score is a direct reflection of a patients ability to heal, said Erik Hoyer, M.D., of the Johns Hopkins University School of Medicine. When a person cannot move his or her legs or use the bathroom independently, for example, its telling us something about the bodys physiologic reserve, its overall ability to be resilient to disease.
All inpatient physical rehab facilities in the United States already require use of the standard Functional Independence Measure (FIM) to assess inpatients physical capacity for a wide range of tasks, including the ability to transfer themselves between a chair and a wheelchair, the toilet or the shower; to walk, eat, bathe and dress on their own, as well as to effectively communicate, socially interact, solve problems and remember important information. The FIM must be conducted within 72 hours of admission to a rehab facility, and the scores are reported to state and national agencies.
Taking advantage of this reporting requirement, Hoyer and his colleagues used various databases to pull information on 9,405 patients admitted to an inpatient rehab facility directly from an acute care hospital between July 2006 and December 2012. The data included general demographic information from each patient, such as age, gender and race/ethnicity, as well as primary diagnosis upon discharge from the hospital, the severity of illness, FIM scores upon admission to rehab and whether he or she was readmitted to an acute care hospital within 30 days of entering rehab.
Breaking the FIM scores into low, medium and high categories, the researchers found that those who scored low on the functionality test were two to three times more likely to be readmitted to the hospital within 30 days than those with high scores. Patients with low FIM scores were significantly more likely to be readmitted to the hospital even after accounting for potential confounders, including age, gender and even severity of illness.
Further investigation showed that out of the three general categories of illness that people enter rehab to treat--medical (such as congestive heart failure), neurological (such as stroke) and orthopedic (such as hip replacement)--those with medical diagnoses were the most likely to head back to the hospital within a month.
Though many researchers have examined factors that may contribute to increased risk of rapid readmission, Hoyer said, none to his knowledge have focused on an overall standard measure of how well patients perform activities necessary for everyday living. One reason may be because few hospitals require inpatients function to be assessed in a standardized way, but with new Medicare reimbursement guidelines in place that cut hospital reimbursements when patients are readmitted within 30 days of discharge, that might drive interest in using similar assessments on patients in general.
Hoyers research is published in the May issue of the Journal of Hospital Medicine and can be found here.
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