Capturing patients’ needs in casemix: a systematic literature review on the value of adding functioning information in reimbursement systems

STROBE. (PDF 28 kb

Linking the Bournemouth Questionnaire for low back pain to the International Classification of Functioning, Disability and Health

Purpose: Understanding the content of health-related quality of life (HRQOL) questionnaires can facilitate comparison and selection of the most appropriate tool in the assessment of patients with low back pain. The International Classification of Functioning, Disability and Health (ICF), as part of the WHO-FIC, can be used as a standardised method for mapping and comparing HRQOL questionnaire content. The purpose of this study was to link the Bournemouth Questionnaire (BQ) to the ICF in order to assess and compare the content of the BQ to the brief ICF core sets for low back pain. Methods: The BQ was linked to the ICF following the rules described by Cieza and Stuki. Following the linking process, the results were further linked to the brief ICF core sets for low back pain. Results: The BQ covered 21 ICF categories within the domains of body functions and activities and participation. Only five meaningful concepts could not be linked to the ICF. The brief core sets for low back pain contain 35 categories, identified as important concepts in back pain patients. The BQ covered 10 of the categories of the brief core sets. Conclusion: HRQOL tools provide valuable information about the health status of patients. Content comparison based on ICF provides relevant information about the concepts covered and enables selection of the appropriate clinical tools. The BQ is easy to administer and is linked to a number of important concepts contained within the ICF and to concepts considered to be important in the assessment of patients with LBP. •Implications for Rehabilitation •Selecting appropriate health-related quality of life (HRQOL) tools can prove difficult, with such a variety of them available, and each with varying content. •ICF provides a standardised framework for the content assessment of HRQOL tools. •Understanding the content of HRQOL tools can facilitate better tool selection and assist in the accurate assessment of patients with low back pain

A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK

Objectives: to identify variables which predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors.Design: a narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (i.e. PsycINFO, CINAHL Plus with full text, MEDLINE, and EMBASE) and completed on March 25th, 2014.Setting: the majority of included studies were set in health services across primary, secondary, specialist, and inpatient care. Some studies used data from household and postal surveys. Participants: included were UK-based studies that predicted HSU by adults with mental disorders, Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders, and dementia.Primary outcome: a wide range of HSU outcomes were examined, including GP contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions, and ‘total HSU’Results: taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, medication, high previous HSU, and activities of daily living were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU. Conclusions: the findings can inform decisions about which variables might be used to derive mental health clusters in ‘payment by results’ systems in the UK. The findings also support the need to investigate whether combining broad diagnoses with care pathways is an effective method for mental health clustering, and the need for research to further examine the association between mental health clusters and HSU.<br/

Accounting for What Matters to Patients in the G-DRG System: A Stakeholder’s Perspective on Integrating Functioning Information

Functioning information constitutes a relevant component for determining patients’ service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information. First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests. This study explores the stakeholder’s perspective on integrating functioning information in the G-DRG system. A qualitative interview study was conducted with national stakeholders in 4 groups of the G-DRG system (health policy, administration, development, and consultations). Interviews were analyzed using inductive thematic analysis. In total, 14 interviews were conducted (4 administration and 10 consultation group). Three main themes were identified: (1) functioning information in the G-DRG system: opportunities and obstacles, (2) general aspects concerning optimizing G-DRG systems by integrating additional information, and (3) ideas and requirements on how to proceed. The study offers insights into the opportunities and obstacles of integrating functioning information in the G-DRG system. The relevance of functioning information was evident. However, the value of functioning information for the G-DRG system was seen critically. Integrating functioning information alone does not seem to be sufficient and a systems approach is needed

Using the refined ICF Linking Rules to compare the content of existing instruments and assessments: a systematic review and exemplary analysis of instruments measuring participation

Background: Existing instruments measuring participation may vary with respect to various aspects. This study aimed to examine the comparability of existing instruments measuring participation based on the International Classification of Functioning, Disability and Health (ICF) by considering aspects of content, the perspective adopted and the categorization of response options. Methods: A systematic literature review was conducted to identify instruments that have been commonly used to measure participation. Concepts of identified instruments were then linked to the ICF following the refined ICF Linking Rules. Aspects of content, perspective adopted and categorization of response options were documented. Results: Out of 315 instruments identified in the full-text screening, 41 instruments were included. Concepts of six instruments were linked entirely to the ICF component Activities and Participation; of 10 instruments still 80% of their concepts. A descriptive perspective was adopted in most items across instruments (75%), mostly in combination with an intensity rating. An appraisal perspective was found in 18% and questions from a need or dependency perspective were least frequent (7%). Conclusion: Accounting for aspects of content, perspective and categorization of responses in the linking of instruments to the ICF provides detailed information for the comparison of instruments and guidance on narrowing down the choices of suitable instruments from a content point of view. Implications for Rehabilitation For clinicians and researchers who need to identify a specific instrument for a given purpose, the findings of this review can serve as a screening tool for instruments measuring participation in terms of the following: • Their content covered based on the ICF. • The perspective adopted in the instrument (e.g., descriptive, need/dependency or appraisal). • The categorization of their response options (e.g., intensity or frequency)

A Rasch-Based Comparison of the Functional Independence Measure and Spinal Cord Independence Measure for Outcome and Quality in the Rehabilitation of Persons with Spinal Cord Injury

OBJECTIVE: The Functional Independence Measure (FIM™) and spinal cord injury (SCI)-specific Spinal Cord Independence Measure (SCIM) are commonly used tools for outcome measurement and quality reporting in rehabilitation. The objective of this study was to investigate the psychometric properties of FIM™ and SCIM and to equate the 2 scales. METHODS: First, content equivalence of FIM™ and SCIM was established through qualitative linking with the International Classification for Functioning, Disability and Health (ICF). Secondly, a Rasch analysis of overlapping contents determined the metric properties of the scales and provided the empirical basis for scale equating. Furthermore, a transformation table for FIM™ and SCIM was created and evaluated. SUBJECTS: Patients with SCI in Swiss inpatient rehabilitation in 2017-18. RESULTS: The ICF linking and a separate Rasch analysis of FIM™ restricted the analysis to the motor scales of FIM™ and SCIM. The Rasch analysis of these scales showed good metric properties. The co-calibration of FIM™ and SCIM motor scores was supported with good fit to the Rasch model. The operational range of SCIM is larger than for FIM™ motor scale. DISCUSSION: This study supports the advantage of using SCIM compared with FIM™ for assessing the functional independence of patients with SCI in rehabilitation