Evaluating the quality of acute rehabilitation care for patients with spinal cord injury: an extended Donabedian model.

摘要

OBJECTIVE: In this study, the researchers examined the quality of rehabilitation care for patients with spinal cord injury (SCI), using an extension of Donabedian's structure, process, outcome model that included environmental and patient characteristic. METHODS: Cluster analysis, univariate variance analysis, and multilevel analysis were used to examine the quality of care for patients with SCI (N = 1974) enrolled in SCI Model Systems between 2000 and 2004. RESULTS: Patients were classified into low-, intermediate-, and high-functioning groups on the basis of admission functional status profiles as measured by the Functional Independence Measure (FIM). Patient profiles and therapy received were found to be related to outcomes measured by FIM gain. Care structure measured by patient volume was found to be negatively associated with outcomes, but facility-level therapist-bed ratios were not related to FIM gain. Medicare Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) interacted with patient profiles influencing FIM gain. CONCLUSION: The results from this study indicated a clear disconnection between the number of therapists and the amount of therapy delivered. This would suggest that potential inefficiency of therapy delivery due to the deployment and allocation of therapy services could be addressed by further consideration of patient profiles that reflect their specific needs and characteristics.