Characteristics of Effective and Efficient Rehabilitation Programs

Objective: To investigate the characteristics of rehabilitation hospitals and units correlated with gains in motor and cognitive function, after adjusting for case severity of the patients admitted and for length of stay (LOS).

Design: The Uniform Data System for Medical Rehabilitation (UDSMR) database was first analyzed to develop a method of adjusting for patient case severity on admission. Rehabilitation programs were surveyed to assess characteristics commonly thought to be associated with efficiency and effectiveness. Data on these characteristics were linked to UDSMR data on patient characteristics and functional gain.

Setting: Seventy-seven rehabilitation hospitals across the United States.

Participants: A total of 37,692 inpatients from the participating rehabilitation hospitals.

Intervention: Comprehensive rehabilitation programs not altered by researcher.

Main Outcome Measures: Program effectiveness was estimated by gains in motor and cognitive subscale scores of the FIM trade mark instrument between admission and discharge, adjusted for indicators of caseload severity at admission. Efficiency was estimated by adjusting gains for LOS as well.

Results: Primary factors affecting both motor and cognitive gains included admission function (treated curvilinearly), age, certain diagnostic distinctions, onset-admission interval, admission class, and LOS. Correlations between staffing intensity and numerous other program characteristics with functional gain were meager, each accounting for less than 2% of variance. LOS was predicted by a number of factors, notably by the percentage of managed care cases (r=-.20), but not by staffing intensity.

Conclusions: Relationships between rehabilitation practices and functional gains by patients do not appear to be simple or overt. Continued research is needed to identify reliable connections between rehabilitative processes and patient outcomes in practice.