Date Presented 04/9/21
This study is the first to compare total and change scores of Section GG to the FIM® for patients with stroke receiving care at inpatient rehabilitation facilities (IRFs). The study’s findings show Section GG has relatively similar response patterns in self-care and mobility as the FIM. Our findings help OTs better understand Section GG and associated regional variations for patients with stroke and potential implications in IRF practice.
Primary Author and Speaker: Chih-Ying Li
Additional Authors and Speakers: Nicole Gerhardt, Madelyn Adams, Bernadette Alpajora, Taylor T. Sivori, and Mary Jane Mulcahey
PURPOSE: The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) mandates post-acute settings to use Section GG items for standardized functional outcome measurement (e.g. self-care and mobility) [1,2]. To examine the performance of GG items, we compared response patterns of self-care and mobility items between Section GG and Functional independent Measure® (FIM) at the inpatient rehabilitation facilities (IRFs) for individuals living with stroke. We also compared Section GG and FIM scores across ten geographical regions defined by the Centers for Medicare and Medicaid (CMS) [3].
DESIGN: Retrospective secondary analyses were conducted using 2017 Uniform Data System for Medical Rehabilitation (UDSMR) national data. We included individuals with stroke of age 18-89 following the IRF-Stroke impairment codes of 01.1-01.4 (left body, right body, bilateral, no paresis) and 01.9 (other stroke) at admission [4]. Each individual was assessed by both Section GG and FIM at admission and discharge at IRFs.
METHOD: We identified seven self-care and six mobility items for Section GG as these items are conceptually equivalent with six self-care and five mobility FIM items. We calculated the change and the total scores of self-care and mobility for both Section GG and FIM at admission and discharge. We examined correlations of change and total scores between Section GG and FIM using Spearman correlation coefficients. We ranked the change and the total scores across ten CMS regions and examined differences and similarities in rankings.
RESULTS: We analyzed a total of 121,640 patients with stroke receiving care at the IRFs. The mean age was 69.1 (SD = 13.3) and the majority is male (52.0%) and White (69.0%). Change scores of Section GG had significantly moderate positive correlations with change scores of FIM (self-care: r = 0.71; mobility: r = 0.56). Total scores of Section GG had higher correlation with FIM at discharge than at admission for both domains (e.g. self-care admission r = 0.85 vs. discharge r = 0.93). Region six (TX, NM, OK, AR, LA) had the highest change score for self-care and mobility for both Section GG and FIM. Section GG mobility had higher percent of exact ranking with FIM mobility (50% of the regions) compared to Section GG/FIM self-care (20%).
CONCLUSION: Overall, patients with stroke had similar scores in Section GG and FIM, with self-care performed better (higher correlation) than mobility, and discharge performed better than admission. Change scores across ten regions had more exact ranking between Section GG and FIM than total scores. Patients living in the South Central regions had the highest change scores and this may be due to the lowest functional scores at admission. Our findings suggest a need for future study to examine the impact of transitioning from FIM to Section GG and how this transition may affect patient care and care quality in 50 populated states.
IMPACT STATEMENT: There has been limited study of response patterns in Section GG at IRFs. It is also unclear whether geographic variations in Section GG scores exist for patients living with stroke. Our study is the first to characterize self-care and mobility scores of Section GG across states and to compare difference and similarities between Section GG and FIM scores for patients living with stroke. Understanding the response patterns of Section GG across the nation will allow occupational therapists prepare value-based post-acute rehabilitation services for patients with stroke. Our finding will potentially guide future post-acute policies and rehabilitation practice in stroke.
References
1. Centers for Medicare and Medicaid Services. IMPACT Act of 2014 data standardization & cross setting measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014/IMPACT-Act-of-2014-Data-Standardization-and-Cross-Setting-Measures.html. Updated December 11, 2018. Accessed March 4, 2020.
2. Centers for Medicare and Medicaid Services. The IMPACT Act and Standardized Patient Assessment Data Elements. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/Downloads/SODF-SPADE-final-July2018.pdf Updated July 25, 2018. Accessed March 4, 2020.
3. Medicare Payment Advisory Commission. Chapter 10 Inpatient rehabilitation facility services. http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch10_sec.pdf?sfvrsn=0 Published March 2019. Accessed June 5, 2019.
4. Centers for Medicare and Medicaid Services. IRF-PAI. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS/IRFPAI. Updated December 17, 2019. Accessed March 4, 2020.
