OBJECTIVE: To develop an index that weights diagnostic information (International Classification of Diseases, 9th revision, Clinical Modification, or ICD-9-CM codes) by the extent to which it is expected to affect functional status and inpatient rehabilitation length of stay (LOS). DESIGN: Eleven nationally prominent physiatrists assigned ICD-9-CM codes to ordinal categories by expected effect on functional recovery. A resulting functional diagnostic complexity index score was calculated for each patient by combining the ranked values of each ICD-9-CM code in the discharge record. Analyses were stratified across the 20 rehabilitation impairment categories (RICs) of the Functional Independence Measure-Function Related Groups. DATA: Patients (182,254) discharged from 465 inpatient rehabilitation units in larger hospitals and free-standing rehabilitation hospitals in 1995. RESULTS: High degrees of diagnostic complexity were associated with low levels of functional independence at admission within each of 20 RICs (Spearman R = .06 to .25). Depending on RIC, patients in the highest (compared with the lowest) complexity category had up to a 35% increase in rehabilitation LOS after accounting for the primary medical reason for rehabilitation and severity of disabilities at admission. CONCLUSION: This prototype index of medical complexity offers a promising approach for analyzing the cumulative effects of diagnoses on patients' initial functional status and rehabilitation LOS.
OBJECTIVE: To develop an index that weights diagnostic information (International Classification of Diseases, 9th revision, Clinical Modification, or ICD-9-CM codes) by the extent to which it is expected to affect functional status and inpatient rehabilitation length of stay (LOS). DESIGN: Eleven nationally prominent physiatrists assigned ICD-9-CM codes to ordinal categories by expected effect on functional recovery. A resulting functional diagnostic complexity index score was calculated for each patient by combining the ranked values of each ICD-9-CM code in the discharge record. Analyses were stratified across the 20 rehabilitation impairment categories (RICs) of the Functional Independence Measure-Function Related Groups. DATA: Patients (182,254) discharged from 465 inpatient rehabilitation units in larger hospitals and free-standing rehabilitation hospitals in 1995. RESULTS: High degrees of diagnostic complexity were associated with low levels of functional independence at admission within each of 20 RICs (Spearman R = .06 to .25). Depending on RIC, patients in the highest (compared with the lowest) complexity category had up to a 35% increase in rehabilitation LOS after accounting for the primary medical reason for rehabilitation and severity of disabilities at admission. CONCLUSION: This prototype index of medical complexity offers a promising approach for analyzing the cumulative effects of diagnoses on patients' initial functional status and rehabilitation LOS.
Authors: Margaret G Stineman; Dawei Xie; Qiang Pan; Jibby E Kurichi; Debra Saliba; Joel Streim Journal: J Am Geriatr Soc Date: 2011-03-01 Impact factor: 5.562
Authors: Stephen P Gulley; Elizabeth K Rasch; Barbara M Altman; Christina D Bethell; Adam C Carle; Benjamin G Druss; Amy J Houtrow; Amanda Reichard; Leighton Chan Journal: Disabil Health J Date: 2017-08-08 Impact factor: 2.554
Authors: Stephen P Gulley; Elizabeth K Rasch; Christina D Bethell; Adam C Carle; Benjamin G Druss; Amy J Houtrow; Amanda Reichard; Leighton Chan Journal: Disabil Health J Date: 2018-01-10 Impact factor: 2.554
Authors: Flora M Hammond; Susan D Horn; Randall J Smout; Cynthia L Beaulieu; Ryan S Barrett; David K Ryser; Teri Sommerfeld Journal: Arch Phys Med Rehabil Date: 2015-08 Impact factor: 3.966