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Efficiency Pattern Analysis for Medical Rehabilitation

Department of Rehabilitation Medicine, University of Pennsylvania Medical Center

James E. Goin, Ph.D.

Center for Clinical Epidemiology and Biostatistics and the General Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania

Byron B. Hamilton, M.D., Ph.D.

Veterans Administration Medical Center, Durham, North Carolina

Carl V. Granger, M.D.

University of New York at Buffalo, Buffalo, New York

Efficiency pattern analysis (EPA) is a technique pro posed for use in medical rehabilitation that links patient functional gain to resource use, as approximated by length of stay (LOS), after adjusting for initial severity. The Functional Independence Measure version of the Function Related Groups (FIM-FRGs) is used to adjust for patient severity and to define the efficiency groups. The efficiency groups are based on LOS and functional gain cut point values in the statistical distribution that are above, below, or within the national interquartile range for each of 53 FRGs. Data from 32,494 patients discharged in 1990 from 123 rehabilitation facilities were used. EPA is a simple way to monitor change in functional gain in response to transformations in health care practices and resource availability. The technique could also provide individual facilities with a means to evaluate treatment efficiencies across time and to com pare patterns of LOS and functional gain to national norms.

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