Relationship between hospital ranking based on Functional Independence Measure (FIM) efficiency and factors related to rehabilitation system for stroke patients -A study of three hospitals participating in Kumamoto Stroke Liaison Critical Pathway-

Nakanishi

Kiyota

et al. 2014

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Objective:The objective of the present study was to determine the differences in FIM improvement (corrected FIM-M effectiveness) in proximal femoral fracture patients due to age. Methods: The subjects were 886 proximal femoral fracture patients. For the formula, Corrected FIM-M effectiveness = FIM-M gain / (A − FIM-M at admission), we determined values of A that would yield a mean FIM-M effectiveness of roughly 0.65. We divided the subjects into seven groups each covering an age range of five-year increments, and we determined the mean corrected FIM-M effectiveness for each group. Results: For FIM-M of 13-18, 19-24, 25-30, and 31-90 points at admission, the value of A was 47, 70, 85, and 91 points, respectively. Corrected FIM-M effectiveness declined with advancing age, especially above 80 years old. Conclusion: Mean FIM improvement in proximal femoral fracture patients begins to decline at age 80, while it was reported to be at age 70 in stroke patients.

Section: Discussionmentioning

confidence: 99%

Relationship between motor FIM improvement (corrected motor FIM effectiveness) and age in proximal femoral fractures

Nakanishi

Kiyota

et al. 2014

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“…Another issue is the fact that the criteria pertaining to the return home rate and NSKH gain remain unchanged even if the percentage of critically ill patients increases. In previous studies, the authors designed a method to correct for severity distribution and effectively compared the NSKH gain, Functional Independence Measure (FIM) gain, length of hospital stay, and return home rate among hospitals participating in the Kumamoto Stroke Liaison Critical Pathway [2][3][4][5]. The method assumes that patients in each hospital are distributed in the same manner as the standard severity distribution (overall severity distribution in all hospitals), allowing calculation of numerical values adjusted for severity distribution.…”

Section: Original Articlementioning

confidence: 99%

“…The return home rate and NSKH gain at each hospital were adjusted using the standard severity distribution. The method of adjustment was similar to that used in previous reports [2][3][4][5]. Specifically, [4].…”

Section: Study 2: Adjusted Nskh Gain and Adjusted Return Home Ratementioning

confidence: 99%

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A study of standard criteria for hospital admission fees using the Nichijo-seikatsu-kino-hyokahyo in Kaifukuki rehabilitation wards

Watanabe

Terasaki

et al. 2013

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A study of standard criteria for hospital admission fees using the Nichijo-seikatsu-kino-hyokahyo in Kaifukuki rehabilitation wards. Jpn J Compr Rehabil Sci 2013; 4: 88-96. Purpose: To consider methods, based on study results, which would allow the differences in severity distribution between hospitals to be reflected in the hospital admission fee standards, using the Nichijoseikatsu-kino-hyokahyo (NSKH). Methods: A sample of 3,389 patients with stroke was analyzed. Scores obtained from NSKH were divided into four categories: scores 0 to 4, 5 to 9, 10 to 14, and 15 to 19. The numbers of patients in the four categories, changes in NSKH score (NSKH gain), and the return home rates were computed for all the participating hospitals and for each of six and other hospitals. We calculated the adjusted NSKH gain and adjusted return home rate at each hospital, using a correction method based on the distribution of NSKH scores for patients in all the participating hospitals (the standard severity distribution). Results: The following differences were found between the hospitals. The percentage of patients identified as "critically ill" (with NSKH scores of 10 to 19) ranged from 29.4 to 44.8%. Patients with NSKH scores of 15 to 19 (severely critically ill patients) occupied 33.6 to 50.2% of the patients with NSKH scores of 10 to 19 (critically ill patients). The mean NSKH scores on admission ranged from 6.52 to 8.60, while the adjusted NSKH gain ranged from 2.23 to 3.50 points and the adjusted return home rates ranged from 58.3 to 74.3%. Conclusion:There may be a need to give higher evaluation to hospitals that show high mean NSKH scores at admission. In addition, adjustment by the standard severity distribution may have to be used in determining NSKH gain and the return home rate.

“…For this reason, it is not possible to make simple comparisons in the mean improvement in FIM (FIM gain) between hospitals that have different proportions of patients' severity (i.e., different severity distributions). Reports that corrected the differences in severity distribution between hospitals before comparing the ADL gain between hospitals include: (1) the technique of using the severity distribution of all hospitals as a "standard severity distribution" and correcting the mean FIM gain at each hospital to a numerical value that assumes that patients are admitted at each individual hospital with the same severity as all the hospitals [2][3][4][5][6][7]; (2) the technique of limiting patients based on their ADL at admission [7,8]; (3) the technique of using the corrected FIM effectiveness [7,9,10]; (4) a case-control study that matched basic attributes [11]; and (5) the technique of using multiple regression analysis to predict FIM at discharge, and clarifying which hospitals had measured values that were higher than the predicted values [12]. The Japanese Journal of Comprehensive Rehabilitation Science (2015)…”

Section: Introductionmentioning

confidence: 99%

The relationship between measured values and values predicted using multiple regression analysis for mean motor FIM at discharge

Nishikawa

Ayu

et al. 2015

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The relationship between measured values and values predicted using multiple regression analysis for mean motor FIM at discharge -A study at 13 Kaifukuki rehabilitation hospitals for stroke patients in the Japan Rehabilitation Database. Jpn J Compr Rehabil Sci 2015; 6: 86-90. Objective: The purpose of this study was to predict mean Functional Independence Measure (FIM) at discharge in patients with stroke from Kaifukuki rehabilitation wards using multiple regression analysis, and to clarify the measured values and predicted values at each hospital. Methods: The subjects were 2,320 stroke patients of 13 Kaifukuki rehabilitation wards registered in the 2014 Japan Rehabilitation Database. For each patient, we found a "measurement/prediction ratio" by dividing the "measured value for motor FIM at discharge" by the "predicted value for motor FIM at discharge obtained by multiple regression analysis", and compared the mean values among hospitals. Results: The 13 hospitals had significant differences in the measurement/prediction ratio for the motor FIM at discharge, ranging from 0.91 to 1.09. Conclusion:The technique of using multiple regression analysis to predict FIM at discharge and comparing the measurement/prediction ratio between hospitals is advantageous in that it can correct the effects of various factors and enables statistical comparisons.