200810 HAPSHSAA PAO Indicators: Stroke Rehabilitation Care

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• 2008-10 HAPS/H-SAA PAO Indicators Stroke
  Rehabilitation Care

August 2007
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Overview

• This session covers Patient Access Outcomes
  stroke rehabilitation care indicators in the
  2008-10 Hospital Annual Planning Submission
  (HAPS) Guidelines and Web-Enabled Reporting
  System (WERS)
• Aimed at hospital and LHIN staff involved in the
  preparation and review of HAPS
• Updated and expanded as needed

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2008-10 HAPS/HSAA Indicators Domains
Training Development
Financial Health
Organizational Health
Capital Health IT/Med Equipment
Turnover Rate
Paid Sick Time (Full-time)
Operational Efficiency
Vacancy Rate
Paid Overtime (Full-time Part-Time)
Capital Health Facility Condition Index
Nursing FTE
Current Ratio Consolidated
Staff Satisfaction
Total Margin Sector Code 1
Workplace Safety Indicators
Total Margin Consolidated
Readmissions to Own Facility
Readmissions (All Facilities CHF Only)
CCC Skin Ulcers
Mental Health
CCC Care Index Indicators
ALC Indicators
Volumes
Rehab Indicators
ED Indicators
Stroke Care Index Indicators
Patient Safety
Hospital-CCAC Integration Indicators
System Integration
Patient Access Outcomes
HSMR
Adult IP Sat Indicators
ED Sat Indicators
Paediatric Sat Indicators
Patient Experience
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2008/10 HAPS/H-SAA Patient Access Outcomes
(PAO) Stroke Rehabilitation Care Indicators

• Monitoring Indicators
• Change in FIM Scores without Length of Stay
  (LOS) Adjustment
• Rehabilitation LOS
• Explanatory Indicators
• Change in FIM Scores with LOS Adjustment
• Rehabilitation LOS Efficiency
• No Performance or Developmental Indicators

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Stroke Rehabilitation Care Indicators Rationale

• Measure outcome of rehabilitation care for a well
  defined group of patients (stroke)
• The expected benefit (measured by change in total
  FIM score) is influenced by patient variables
  these are used to adjust the expected FIM change
• LOS strongly influences FIM change while this
  must be accounted for in explaining outcomes, it
  ought not to be used to adjust for the monitoring
  indicator of expected benefit per patient

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Stroke Rehabilitation Indicators Changes in
2008-10

• Stroke cases are grouped according to the RPG
  grouper (rather than the RCG grouper)
• All analyses to determine expected rates or
  values use the RPG group as a factor rather than
  the RCG group

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Monitoring Indicator Change in Total FIM Score
(unadjusted for LOS)

• Description
• Change in Total FIM Score for patients with a
  stroke RPG admitted to designated beds for
  rehabilitation activity, adjusted for patient
  age, RPG group and baseline FIM, but not Length
  of Stay.
• Definition

Change in Total FIM Score, unadjusted for LOS
(Stroke Patients only)
Observed difference of sum of scores for all 18
elements of FIM upon admission and at discharge,
averaged for all patients with stroke RPGs within
a facility

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Monitoring Indicator Change in Total FIM Score
(unadjusted for LOS)

• Inclusion Criteria
• Patients with Stroke RPGs (1100, 1110, 1120,
  1130, 1140, 1150, 1160) in Designated
  Rehabilitation institutions (GR or SR)
• Exclusion Criteria
• Missing data on total FIM scores, age or LOS

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Monitoring Indicator Change in Total FIM Score
(unadjusted for LOS)

• Calculation
• For each eligible patient, sum the scores for all
  18 elements on the FIM instrument (ranging from
  18 to 126) measured on admittance and discharge.
• To calculate Change in Total FIM Score for each
  eligible Patient, subtract Total FIM Score on
  Admission from Total FIM Score on Discharge
• To calculate facility-wide Average Change in
  Total FIM Score, add the Change in Total FIM
  Score across all patients and divide by the total
  number of eligible patients in the facility

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Monitoring Indicator Change in Total FIM Score
(unadjusted for LOS)

• Expected Change in Total FIM
• The Expected Change in Total FIM is based on an
  analysis of province-wide results, linking
  patient-level FIM changes to factors including
  RPG group assignment, baseline total FIM score
  and age but not LOS. The Expected Change in Total
  FIM scores are provided in a lookup table in
  WERS.
• Target Corridors
• Target is the Expected FIM Change. The corridor
  is 3 standard deviations below

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Monitoring Indicator Stroke Rehabilitation
Length of Stay (LOS)

• Description
• Length of stay (LOS) for patients with a stroke
  RPG admitted to designated beds for
  rehabilitation activity.
• Definition

Rehab LOS (Stroke Patients Only)

Facility-wide average of Date of Discharge
Date of Admission (excluding service interruption
days),
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Monitoring Indicator Stroke Rehabilitation
Length of Stay (LOS)

• Inclusion Criteria
• Patients with Stroke RPGs (1100, 1110, 1120,
  1130, 1140, 1150, 1160) in Designated
  Rehabilitation institutions (GR or SR)
• Exclusion Criteria
• Missing data on total FIM scores, age or LOS

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Monitoring Indicator Stroke Rehabilitation
Length of Stay (LOS)

• Calculation
• The indicator is facility-wide Average Length of
  Stay for all eligible stroke patients where LOS
  is the number of days between the admission date
  and discharge date from the rehabilitation
  facility, minus service interruption days.
• Expected LOS for eligible stroke patients is
  based on a regression model relating LOS to
  patient factors including RPG group assignment
  baseline total FIM score and age. These are in a
  look-up table on WERS

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Monitoring Indicator Stroke Rehabilitation
Length of Stay (LOS)

Targets Corridors Target is the facility-wide
Expected Length of Stay. The corridor is 3
standard deviations above the Target.

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Explanatory Indicator Change in Total FIM Score
(adjusted for LOS)

• Description
• Change in Total FIM Score for patients with a
  stroke RPG admitted to designated beds for
  rehabilitation activity, adjusted for patient
  age, RPG group, baseline FIM and Length of
  Stay.
• Definition

Change in Total FIM Score, adjusted for LOS
(Stroke Patients only)
Observed difference of sum of scores for all 18
elements of FIM upon admission and at discharge,
averaged for all patients with stroke RPGs within
a facility

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Explanatory Indicator Change in Total FIM Score
(adjusted for LOS)

• Inclusion Criteria
• Patients with Stroke RPGs (1100, 1110, 1120,
  1130, 1140, 1150, 1160) in Designated
  Rehabilitation institutions (GR or SR)
• Exclusion Criteria
• Missing data on total FIM scores, age or LOS

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Explanatory Indicator Change in Total FIM
Score (adjusted for LOS)

• Calculation
• As for the monitoring Change in Total FIM Score
  indicator, calculate the facility-wide Average
  Change in Total FIM Score
• Expected Change in Total FIM adjusted for LOS
• The Expected Change in Total FIM adjusted for
  LOS is based on factors including RPG group
  assignment, baseline total FIM score, age and
  LOS. These are provided in a lookup table in
  WERS.
• Target Corridors
• None for explanatory indicators

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Explanatory Indicator Stroke Rehabilitation LOS
Efficiency

• Description
• Change in total function score per day of client
  participation in the rehabilitation program,
  excluding service interruption days
• Definition
• Note This indicator is not adjusted for
  patient age or Admission FIM Score

Rehab LOS Efficiency (Stroke Patients only)
Facility-wide average of the patient-level
observed difference of sum of scores for all 18
elements of FIM upon admission and at discharge
divided by divided by the patients Total
Rehabilitation LOS

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Explanatory Indicator Stroke Rehabilitation LOS
Efficiency

• Inclusion Criteria
• Patients with Stroke RPGs in Designated
  Rehabilitation institutions (GR or SR)
• Exclusion Criteria
• Missing LOS data
• Calculation
• For each eligible patient, sum the scores for all
  18 elements on the FIM instrument measured on
  admittance and discharge.
• Calculate the change in Total FIM Score for
  each eligible (discharge score admission
  score).
• Calculate the patient Total LOS as above
  (excluding service interruption days)
• For each patient, divide the Change in Total FIM
  Score by the Total LOS, and average these rates
  across the facility

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Stroke Rehabilitation Care Indicators
Interpretation of Results

• Facilities performing well with monitoring
  indicator for FIM (unadjusted for LOS) but less
  well with explanatory indicator for FIM
  (adjusted for LOS)
• gt achieving relatively good clinical outcomes,
  but perhaps less efficiently
• Facilities performing less well with monitoring
  indicator for FIM (unadjusted for LOS) but well
  with explanatory indicator for FIM (adjusted for
  LOS)
• gt achieving relatively poor clinical outcomes,
  but these at least as good as would be
  expected with the relatively short LOS

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More Information

• Development of the Rehabilitation Patient Group
  (RPG) Case Mix Classification Methodology and
  Weighting System for Adult Inpatient
  Rehabilitation, JPPC Technical Report (October
  2006), www.jppc.org
• Evaluation and Selection of a Grouper and
  Weighting Methodology for Adult Inpatient
  Rehabilitation Care, Summary Report of the JPPC
  Rehabilitation Technical Working Group (October
  2006), www.jppc.org
• Other e-Learning and background materials in this
  series are posted on www.oha.com, with links on
  WERS, FIM, LHIN and JPPC websites
• If you have questions, please contact your local
  LHIN www.lhins.on.ca

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We Welcome Your Feedback

• For more information on this e-Learning series or
  other initiatives of the LHIN-JPPC Communication
  Education Work Group please contact
• Mimi Lowi-Young, Chair
• c/o Ontario Joint Policy and Planning Committee
  (JPPC)
• 415 Yonge Street, Suite 1200
• Toronto, ON M5B 2E7
• Tel [phone] Fax [phone]
• www.jppc.org