A taxonomy for classification of stroke rehabilitation services.

OBJECTIVE To develop a taxonomy for use in measuring stroke rehabilitation services. DESIGN A cross-sectional study using facility-level survey data and extant data files. SETTING Veterans Administration medical centers (VAMCs). VARIABLES (1) A list of rehabilitation characteristics, including personnel, physical facilities, coordination of care, and hospital characteristics; and (2) a classification or typology of VAMCs according to the type of postacute stroke care on-site. MAIN OUTCOME MEASURES Data sources included extant Veterans Administration (VA) computerized databases, VA central office administrative files, and 2 mailed surveys to VA rehabilitation medicine services and stroke acute care services. The rehabilitation taxonomy was derived using 2 methods that assess face and construct validity, respectively: (1) an expert panel rating, using a modified Delphi process, of the clinical importance of each of the rehabilitation characteristics; and (2) a comparison of rehabilitation characteristics across the different types of VAMCs. Variables were included in the final taxonomy if the expert panel reached consensus that the variable was clinically important, or if there were statistically significant differences in these characteristics across the different types of medical centers. RESULTS Of 67 possible rehabilitation characteristics, a multidisciplinary expert panel reached consensus about the likely clinical importance of 21 rehabilitation characteristics, 11 of which showed statistically significant differences across different types of VAMCs. An additional 9 variables that lacked expert panel consensus differed significantly among the different medical centers. These 30 variables represent a preliminary taxonomy of key rehabilitation characteristics. Among the 20 variables that varied significantly across the different types of medical centers, 18 showed a pattern with the greatest amount of resources and organizational sophistication being found in VAMCs with rehabilitation units, followed by medical centers with geriatric units, and the least amount of resources and organizational sophistication was seen in medical centers whose postacute care services were limited to nursing home or intermediate care. CONCLUSION Thirty rehabilitation characteristics had face validity and/or construct validity, and can be considered to represent a preliminary taxonomy for measuring stroke rehabilitation services. This study also shows that there are significant differences among hospitals in resources and organization of care deemed to be important for stroke patients.

[1]  Marcus J. Fuhrer,et al.  Assessing medical rehabilitation practices : the promise of outcomes research , 1998 .

[2]  M. Fuhrer.  Response and Commentary: Comments on: Rehabilitation Care and Outcomes from the Patient's Perspective, presented by Andrew M. Kramer, MD , 1997 .

[3]  W. J. Conover,et al.  Practical Nonparametric Statistics , 1972 .

[4]  P. Langhorne,et al.  Do stroke units save lives? , 1993, The Lancet.

[5]  L. Rubenstein,et al.  Impacts of Geriatric Evaluation and Management Programs on Defined Outcomes: Overview of the Evidence , 1991, Journal of the American Geriatrics Society.

[6]  Pamela W. Duncan,et al.  Post-stroke rehabilitation: Assessment, referral and patient management , 1995 .

[7]  Langhorne,et al.  Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke , 1997, BMJ.

[8]  B. Wilde,et al.  Quality of care from the patients' perspective: Development of a patient-centred questionnaire based on a grounded theory model , 1994 .

[9]  R. A. Groeneveld,et al.  Practical Nonparametric Statistics (2nd ed). , 1981 .

[10]  R. Brook,et al.  Consensus methods: characteristics and guidelines for use. , 1984, American journal of public health.

[11]  K. Bailey.  Typologies and taxonomies: An introduction to classification techniques. , 1994 .

[12]  K J Ottenbacher,et al.  The results of clinical trials in stroke rehabilitation research. , 1993, Archives of neurology.

[13]  C. Granger,et al.  The Uniform Data System for Medical Rehabilitation: report of first admissions for 1994. , 1996, American journal of physical medicine & rehabilitation.

[14]  Kashner Tm.  Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. , 1998 .

[15]  E. Clipp,et al.  New horizons in stroke rehabilitation research. , 1999, Journal of rehabilitation research and development.

[16]  J A Hastings,et al.  A method of residual limb stiffness distribution measurement. , 1999, Journal of rehabilitation research and development.

[17]  S. Slørdahl,et al.  Stroke unit treatment. Long-term effects. , 1997, Stroke.

[18]  W. Fisher,et al.  Applying psychometric criteria to functional assessment in medical rehabilitation: III. Construct validity and predicting level of care. , 1992, Archives of physical medicine and rehabilitation.

[19]  Charges for outpatient rehabilitation: growth and differences in provider types. , 1996, Archives of physical medicine and rehabilitation.

[20]  C. Granger,et al.  UDS report. The Uniform Data System for Medical Rehabilitation Report of First Admissions for 1990. , 1992, American journal of physical medicine & rehabilitation.

[21]  S. Yeh,et al.  Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care , 1997 .

[22]  J. Lehmann,et al.  Krusen's Handbook of Physical Medicine and Rehabilitation , 1990 .

[23]  A. Kramer,et al.  Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. , 1997, JAMA.