In today?s environment, a successful health-care provider must be able to respond to the increasing appetite from consumers for information regarding the quality of services. Allied Services Integrated Health System has built a culture around continuous improvement and outcomes of care.

The Gold Standard in Inpatient Rehab Outcomes

Originally developed by the Uniform Data System for Medical Rehabilitation, the FIM measures a person?s level of independence in performing 18 common activities. The activities include self care tasks such as eating, bathing, and dressing; bowel and bladder control, transferring from a chair or toilet to a standing position, ambulating, and climbing stairs. Each item is rated on a scale from 1 (the person is completely dependent on the help of others to perform the task) to 7 (the person is completely independent in performing the task). Scores for each activity are summed to offer the rehabilitation team an overall indicator of the patient?s functional ability. Typically, FIM scores are assessed at the time of admission and again at discharge, allowing providers to measure the amount of improvement patients made during the rehabilitation episode. FIM scores not only measure functional improvement, but are also used as the basis for the Medicare IRF prospective payment system.

The goal of an inpatient rehabilitation program is to see the patient return home as safely and independently as possible. Allied Services Integrated Health System treats about 4,000 patients per year in its two inpatient rehabilitation hospitals. Our skilled treatment teams utilize evidence-based care models focusing on maximum functional status improvement. Patients receive at least three hours of therapy, five days a week. The goals worked on with physical, occupational, and speech therapy are reinforced by our nursing staff with specialized certification in rehabilitation. This consistent approach to addressing the patient?s functional needs allows for significant improvements in a short period of time.

Functional status is a key component of quality outcomes in inpatient rehabilitation. Functional status is measured using a tool called the FIM (see inset). In 2010, Allied Services Discharge FIM, FIM Change, LOS, and LOS Efficiency were significantly better than risk-adjusted national benchmarks.

  • Mean FIM Change was 25% greater than the risk-adjusted national comparison.
  • Mean IRF LOS was 10.2 days, over 4 days less than national averages.
  • Our mean LOS Efficiency was 69% greater than the risk-adjusted national benchmark.

?These results don?t happen by accident? said Dr. Greg Basting, Vice President of Medical Affairs at Allied Services. ?Our clinical teams have a level of experience that is difficult to duplicate. Surveyors from high profile post-acute providers have been through our facilities, and they are consistently impressed by the longevity, skill, and dedication of our team. Our staff, along with the organization?s commitment to the latest rehab technology, has given our system an advantage in achieving great outcomes.?

Other important outcomes include where a patient goes following discharge from an IRF. IRFs routinely examine the percentage of patients that are discharged to the community (defined as home or a home-like setting not reimbursed by Medicare, such as an assisted living facility), as well as, the percentage of patients that are discharged to acute care facilities.

The goal of an inpatient rehabilitation program is to see the patient return home as safely and independently as possible. ?Functional improvement is only a part reaching that goal?, Kathy Stella, Director of Case Management noted. ?Patients who come to inpatient rehab facilities are sick; they need daily supervision by a physician specializing in rehabilitation. Medical management of these cases makes sure patients don?t bounce back to the acute care facilities. And to go home safely, it takes a coordinated planning effort. Making sure that patients and their families are educated on how to manage their conditions when they go home, making sure that they understand their medication regimes, coordinating post-discharge appointments, and communicating with family physicians are keys to getting people home safely.? In 2010, our percentage of patients discharged to the community was 11% greater than risk adjusted national benchmarks, while the percentage of patients discharged to acute care facilities was 17% less than those same benchmarks.

In 2008, UDSmr began a program that recognized facilities with the very best outcomes. The Top Performer Award is issued annually to those facilities who ranked in the top 10% of IRFs participating in the UDSmr member database (which consists of about 800 IRFs). The award uses an overall quality score that is a composite of discharge FIM, FIM change, LOS efficiency, the percentage of patients discharged to the community and the percentage of patients discharged to acute-care facilities. This composite score is then compared to scores of all participating facilities and a percentile rank is assigned to each facility. In 2010, both Allied Services IRFs received the Top Performer Award. Wilkes-Barre Rehab Hospital ranked in the top 4% of facilities nationwide, while the Scranton Rehab Hospital ranked in the top 1%. ?We take these results very seriously.? noted Basting. ?Our mission is to be the best rehab provider. Our clinical team has embraced that challenge, and has delivered on the quality of care promise that we make to our patients.?