Discharge destination and motor function outcome in severe stroke as measured by the functional independence measure/function-related group classification system

OBJECTIVES

Function-related groups based on the Functional Independence Measure have been proposed as a model for a prospective payment system for medical rehabilitation. This study describes discharge destination and motor function outcomes in a sample of patients with stroke from the FIM-FRG STR1 classification.

STUDY DESIGN

A retrospective review of 293 cases of stroke from the years 1993 to 1995. The demographic and outcome characteristics of this sample were described.

RESULTS/CONCLUSIONS

Forty-five percent of the patients were discharged to home after a mean length of stay of 23.8 days in acute medical rehabilitation. Patients who were discharged home had higher admission and discharge motor FIM scores than those discharged to a subacute facility or long-term care facility, although the correlation between motor FIM score and discharge destination was low to moderate. Median discharge motor FIM scores indicate considerable residual disability in this classification after rehabilitation. Research problems that address methods to improve the usefulness of the FIM-FRG system in a prospective payment system are discussed.

Comprehensive medical rehabilitation in the 1990s: the community integration rehabilitation model

The development of new models of understanding the disabling process, the changing system of financing health care in the United States, and the increasing incidence of disability is challenging rehabilitation to define new models of care delivery. Current models of comprehensive medical rehabilitation include multidisciplinary therapy in inpatient, outpatient, home and community settings. Managed care and the development of capitated funding systems for health care financing will challenge rehabilitation to prevent disability in a population. This article proposes a model system for comprehensive rehabilitation in managed care: the Community Integration Rehabilitation Model. This system advocates the development of a continuum of services including a strong community-based rehabilitation system, that is, a shift in emphasis to expanding opportunities for independent and productive community living as well as management of disease and impairment for individuals with disabilities, and the forging of partnerships between institution-based rehabilitation and its community. Comprehensive rehabilitation is redefined as a continuum of disability prevention and treatment across the lifespan of a population.

Development of a comprehensive staff education plan for a rehabilitation center

Staff education will be an important component of managing changes in health care. The development of a "learning organization" will necessitate developing management processes to encourage team building and participation. This article describes a management process created to develop a comprehensive staff development plan for a rehabilitation center. Four components of the management process are described: formation and articulation of a mission statement, establishment of an organizational structure, development of educational plan procedures, and description of the role of the management team in developing the plan. Strategies for plan implementation and evaluation are also discussed.