4.1 Evaluation of Patient Functional Status

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Description of Indicator

Relationship to Quality Medical care should be effective
Type of Indicator Hospital process, Hospital level
Proposed Data Source Trauma Registry
Definition Number of patients with assessments for disability and decisions regarding prescriptions for post-acute care therapy per 100 patients
Numerator All patients age 18 years and older admitted to hospital with an injury diagnosis AND documented to have an assessment for disability* AND a decision to prescribe OR not prescribe post-acute care therapy‡
Denominator All patients age 18 years and older admitted to hospital with an injury diagnosis
Benchmark Not specified at present
Risk Adjustment Not applicable

* Documented assessment for disability could be performed by the admitting physician service, consulting physiatrist, consulting geriatrician, physical therapist, occupational therapist and/or speech therapist.
‡ Post-acute therapy can be inpatient (e.g. inpatient rehabilitation unit) or outpatient and could include treatment from physical therapists, occupational therapists and/or speech therapists.

 

Summary
This indicator is intended to monitor whether patient function is assessed while still in hospital and whether a decision is made regarding the need for post-acute care therapy. Not all injured patients are likely to benefit from therapy following discharge from acute care. However, assessment of function and decision-making regarding prescription of post-acute care therapy can perhaps be most efficiently performed during initial acute care hospitalization.

 

Panel Review
Panelists reported that the indicator measures an important aspect of posthospital healthcare, but that there were many implementation challenges from a trauma system perspective, specifically provider and institution specific practice patterns and the need for additional data collection. Panelists suggest that opportunities may exist to develop quality indicators focused on resource delivery following hospital discharge.

 

Trauma Center Review
While the trauma centers reported the indicator to be valuable, many suggested that the cost of implementation was likely to be too great. Centers indicated that current practices make access to the necessary information difficult and that implementation would require increased documentation as well as communication between trauma registries and other medical record registries. It was also noted that practice variation between institutions may complicate measurement.

 

Review of Literature & Evidence
Face Validity: No studies identified.
Construct Validity: One study demonstrated that reduced transfer delay to rehabilitation was associated with a reduction in rehabilitation length of stay and better cognitive functional outcomes in traumatic brain injured patients at discharge103.
Reliability: No studies identified.
Risk Adjustment: Not applicable.
Utilization: Indicators focused on rehabilitation therapy are used by a small number of trauma centers: USA 2% (3/200), Canada 9% (3/35), Australasia 0% (0/12).
Discussion of this indicator in the literature is almost non-existent. However, there appears to be a suggestion that early access of patients to rehabilitation may be associated with better patient outcomes for patients and more economical use of resources in both the acute and rehabilitation environments103.

 

Source
The indicator Rehabilitation Facility Transfer was proposed by the Trauma Quality Indicator Consensus Panel and revised to Therapy Evaluation based on panel member feedback.

 

References
103. Sirois MJ, Lavoie A, Dionne CE. Impact of transfer delays to rehabilitation in patients with severe trauma. Arch Phys Med Rehabil. 2004;85(2):184-191.